Experiences on Antiviral Treatment for Chronic Viral B and C Hepatitis in Hungary (1998–2004). A Nation-Wide Study

Abstract

Introduction: In the past decade several multicentre, prospective, randomised trials have revealed a significant progress in the therapy for chronic viral hepatitis, but only limited and contradictory data are available regarding the real value of the antiviral treatment in the everyday routine clinical practice. Objective: A nation-wide retrospective analysis has been performed in order to assess the efficacy of antiviral therapy for patients with chronic hepatitis B and C representing the entire population that needed treatment in Hungary during a seven-year period. In addition, results of a prospective Hungarian study including patients with chronic hepatitis C are also presented. Patients and methods: A total of 220 patients with chronic hepatitis B treated with standard interferon-alpha (112), pegylated interferon-alpha-2a (23) or lamivudine (85) were investigated and the ratio of HBeAg seroconversion and/or undetectable HBV-DNA has been assessed. Of the 2442 patients with chronic hepatitis C, 333 were treated with standard interferon monotherapy, 1122 with standard interferon + ribavirin and 987 with pegylated interferon + ribavirin combination for 6 to 12 months. In a prospective study, 69 patients with chronic hepatitis C were enrolled and treated with pegylated interferon-alpha-2a + ribavirin. The rate of sustained virological response, the predictors of outcome and the adverse effects of treatment were evaluated. Results: For HBV patients standard IFN, PEG-IFN and lamivudine provided 31, 30, and 31 to 33% sustained virological response rate, respectively. In chronic hepatitis C, a continuous improvement was noted in sustained virological response, from 13% with interferon monotherapy to 31% with pegylated interferon + ribavirin combination, while even a 48% sustained virological response has been achieved in the prospective trial. The most important predictors of outcome were the 4-week ‘rapid’ and 12-week ‘early’ virological responses, then female gender, age, BMI and adherence. The most frequent complications of the treatment were cytopenia, haemolysis and depression, occurring in 9% of patients. Conclusion: Unlike in HBV infection, in chronic HCV hepatitis the efficacy of antiviral treatment has gradually improved in our everyday clinical practice, but the results are far poorer than those achieved in a prospective study. To manage the growing populations of hard-to-treat patients with chronic viral hepatitis, there is a need for more effective treatment modalities, including optimalized, individualized dosing and novel antiviral agents.