Treatment of Hepatitis C

Abstract

Purpose: Chronic HCV infection is highly prevalent in the VA population but its treatment may be compromised by ETOH/drug use, psychiatric contraindications, and co-morbid conditions. Response rates and adherence to treatment have been reported to be lower in this population. AIMS: To describe the clinical experience of treating patients infected with hepatitis C at a single VAMC. Methods: Retrospective review of naive veteran pts with HCV infection treated with combination Pegylated interferon α (either 2b or 2a) + Ribavarin (Riba). All patients had their genotype determined at entry. Initiation of treatment was decided by a gastroenterologist but the administration and follow-up was closely monitored by a nurse practitioner under his/her direct supervision. Sustained virological response (SVR) was assessed 6-months after discontinuation of therapy in those with end of treatment response on an ITT and completion of therapy analysis. Results: A total of 186 pts (115 Peg-Ifn 2b; 71 Peg-Ifn 2a) had completed treatment, were 6-mo beyond discontinuation of treatment, and could be evaluated for SVR. The average age was 51. The overall SVR for all genotypes was 43.5% with a discontinuation rate of 26.9%. The discontinuation rate was independent of Interferon type. There were no significant overall differences between the two forms of Peg-Ifn regarding SVR. Analysis of weight showed a slightly higher BMI for non-SVR in the Peg-Inf 2a group (29.3) vs. Peg-Inf 2b group (28.6). (p = NS) Side effects were the cause of discontinuation in 62% of cases whereas other causes (non-compliance, financial/work-related issues, etc) represented 32%. Three patients discontinued therapy due of liver decompensation. Conclusions: Even in a tightly monitored environment the SVR for all genotypes was lower than those reported in the literature but higher than previously reported in other VA populations. Side effects or reasons other than no-response accounts for a 27% discontinution rate. There is a trend for slightly lower SVR in higher BMI patients treated with Peg-Inf 2a vs. Peg-Inf 2b. Intense monitoring results in higher SVR than previously reported in this population. Table: SVR Rates on ITT & (Completed Treatment)