Abstract
BackgroundHepatitis C genotype 6 (HCV-6) is prevalent in Southeast Asia. Data on the efficacy of direct-acting antiviral agents in chronic HCV-6 patients is limited and pegylated interferon (Peg-IFN) plus ribavirin (RBV) combination therapy remains standard therapy for those patients.AimMeta-analysis was performed to assess the efficacy and safety of Peg-IFN plus RBV combination therapy for chronic HCV-6 patients.MethodsRelevant studies were found by database search through Medline, Embase, Web of Science and The Cochrane Library. All published clinical trials assessing the efficacy of Peg-IFN plus RBV combination therapy for chronic HCV-6 patients were included. Sustained virological response rate (SVR) was pooled. We performed additional meta-analyses to compare the SVR outcomes of 24 versus 48 weeks of treatment in four head-to-head trials. Another second meta-analysis was also conducted to compare the efficacy of combination Peg-IFN plus RBV therapy in HCV-6 versus HCV-1 patients.ResultsThirteen studies met the inclusion criteria. The pooled SVR of all single arms was 75% (95% CI: 0.68–0.81). The SVR of 24 weeks treatment was significantly lower than that at 48 weeks, with a risk difference of −14% (95% CI: −0.25 to −0.02, p = 0.02). However, when restricted to the patients with rapid virological response (RVR), there was no significant effect on SVR between these two treatment groups, with a risk difference of −1% (95% CI: −0.1 to 0.07, p = 0.67). The SVR in HCV-6 patients was significantly higher than that in HCV-1 patients, with a relative risk of 1.35 (95% CI: 1.16–1.57, p<0.001). Side effects were common, but rarely caused treatment discontinuation.ConclusionsThe results of this meta-analysis suggest that Peg-IFN plus RBV is effective and safe for HCV-6 patients. Shortening treatment seems to be feasible in HCV-6 patients with RVR when tolerance to treatment is poor. However, this decision should be made cautiously.
Highlights
HCV infection frequently causes liver cirrhosis and liver cancer
The results of this meta-analysis suggest that pegylated interferon (Peg-IFN) plus RBV is effective and safe for HCV genotype 6 (HCV-6) patients
Shortening treatment seems to be feasible in HCV-6 patients with rapid virological response (RVR) when tolerance to treatment is poor
Summary
Almost 3% of the world population have chronic HCV infection, and over 350,000 people die annually due to advanced liver disease [1]. HCV genotypes have a varied geographic distribution around the world. HCV genotype 4 is mostly distributed in the Middle East and North Africa, while genotype 5 is limited to South Africa. Of the primary HCV genotypes, genotype 6 is one of the most prevalent in Southern China and Southeast Asia, contributing to almost 30% of all HCV-infected patients in these areas [5]. Among the subtypes of HCV-6, subtype 6a is the most geographically limited having been discovered only in Vietnam, Macau and Hong Kong, or emigrants from those countries [6]. Hepatitis C genotype 6 (HCV-6) is prevalent in Southeast Asia. Data on the efficacy of direct-acting antiviral agents in chronic HCV-6 patients is limited and pegylated interferon (Peg-IFN) plus ribavirin (RBV) combination therapy remains standard therapy for those patients
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