Rapid virologic response: a new milestone in the management of chronic hepatitis C

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Clin Infect Dis. 2008 Jan 1;46(1):78-84.Related Articles,

Rapid virologic response: a new milestone in the management of chronic hepatitis

C.

Poordad F, Reddy KR, P.

Hepatology and Liver Transplantation, Cedars-Sinai Medical Center, Los Angeles,

California 90048, USA. Fred.Poordad@...

BACKGROUND: Rapid virologic response (RVR), defined as an undetectable serum

hepatitis C virus (HCV) RNA level at week 4 of treatment, is emerging as an

important milestone in the treatment of patients who have chronic hepatitis C by

use of pegylated interferon-alfa and ribavirin--the current standard of care.

This assessment is being used to individualize treatment duration, which is

currently recommended as 48 weeks in patients infected with HCV genotype 1 (G1)

and 24 weeks in those infected with HCV G2 or G3. METHODS: We collated

information from studies including assessment of HCV RNA level at week 4,

specifically highlighting the relationship between RVR and other predictors of

treatment outcome and the manner in which RVR can be used to optimize treatment

outcomes for specific patient groups. RESULTS: The role of RVR in the treatment

of patients with chronic hepatitis C varies according to viral genotype. Among

patients with HCV G2/G3 infection, several studies have shown that shortening

the treatment duration to 12-16 weeks is effective among those who attain RVR.

In contrast, RVR may be used as an indicator for both shortened and extended

treatment durations among patients with HCV G1 infection. HCV G1-infected

patients with low baseline viral load who attain RVR may be effectively treated

for 24 weeks, whereas patients who do not attain RVR may be candidates for an

extended 72-week regimen. CONCLUSIONS: RVR is rapidly becoming a new tool for

predicting treatment outcomes in patients with chronic hepatitis C and

represents a key opportunity to individualize therapy according to

treatment-related viral kinetics.

PMID: 18171217 [PubMed - in process]

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