Retreatment of Chronic Hepatitis C Virus (HCV): Predictors of Response

Abstract

Introduction: HCV chronically infects millions and contributes to significant morbidity and mortality. Although modern Direct Acting Antiviral (DAA) based therapies have much proven success in curing infection, management of chronic HCV who have failed treatment is problematic. Our study seeks to assess clinical predictors of retreatment response in patients who have previously failed anti-HCV therapy. Methods: A retrospective analysis was conducted on a sample of patients, who had previously failed treatment for chronic HCV infection, seen at the Liver Associates of Texas Hepatology clinics between September 2015 and October 2016. The cohort consisted of 19 total patients who had failed prior DAA -based or interferon-based therapy. The 19 patients were then retreated with extended DAA +/- ribavirin. 16 achieved Sustained Viral Response (SVR) at 12 weeks. Retreatment responders and retreatment nonresponders were compared in terms of clinical variables including BMI, ethnicity, presence of portal hypertension and age as predictors of response. Chi Squared and ANOVA analyses were used to compare differences between the groups. Results: Out of the 19 patients in the analysis, 68% had initially failed interferon-based regimens while the other 32% of patients had failed DAA-based treatment. 47% of the sample was African American, 26% Caucasian, 11% Hispanic. Majority of these patients fell in the 55-79 year-old age group (84%), and of the total 19, 58% were male and 42% were female. The median viral load at presentation in the sample was 815,687 IU/ml. Gender, age, portal hypertension status, diabetic status and ethnicity were not significantly different between the two groups. BMI, however, was significantly lower in the retreatment group that achieved SVR12 with responders having a mean BMI (Kg/m2) of 28.27 Vs 38.67 in the nonresponders (p=.003). Conclusion: Despite a small sample size, this study suggests that a low BMI was a positive predictor of response in retreatment of patients who had failed prior treatment for chronic HCV. This difference may be due to a variety of factors including baseline metabolic differences, liver injury, or even overall health and well-being.