Baseline viral load - a predictor of treatment response in advanced hepatitis C

Abstract

PURPOSE: The stage of liver disease and genotype of hepatitis C virus (HCV) are well-defined predictors for therapeutic success in chronic hepatitis C. This study aimed at assessing the prognostic role of baseline viral load for response to antiviral therapy in genotype 1 infected patients. MATERIAL AND METHODS: The study covered a total of 163 patients with hepatitis C, 93 of them with absent, mild or septal fibrosis (F0-F2) and 70 cases with bridging fibrosis (F3) or cirrhosis (F4). Viral load (HCV RNA) was determined with a sensitive RT-PCR technique. A high baseline viraemia was defined if HCV RNA exceeded 600000 IU/mL. All the patients were treated with peginterferon alfa and ribavirin for 24 to 48 weeks. They achieved a sustained viral response (SVR) if HCV RNA was undetectable six month after therapy cessation. RESULTS: SVR was registered in 80.6% of the patients with F0-F2 fibrosis stage, in 51.4% of those with F3-F4 fibrosis and in only 25% of 12 patients with early Child B cirrhosis or with present esophageal varices. Baseline viral load was not a prognostic factor for therapeutic effectiveness in early hepatitis C stage. However, in the advanced fibrosis stage, patients who achieved viral eradication had a significantly lower level of HCV RNA (440000 IU/mL) then those with relapse or non-response to therapy (997000 IU/mL). CONCLUSION: The most difficult-to-treat patients with HCV genotype 1 and advanced liver disease may successfully receive a standard treatment. The SVR rate is 51.4%, reaching the results of current triple therapy for F3-F4 stage. The viral eradication is associated with a low baseline viral load. Scripta Scientifica Medica 2013; 45(3): 53-57.