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Background:
Rapid virological response (RVR) strongly predicts sustained virological response (SVR) in patients with chronic hepatitis C (CHC), and abbreviates antiviral therapy in some patients.
Hepatitis Monthly
Official Journal of Research Center for Gastroenterology and Liver Diseases
Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy
Author(s):
Kung-Hung Lin2, 
Hsien-Chung Yu1,*, Ping-I Hsu1, Wei-Lun Tsai1, Wen-Chi Chen1, Chun-Ku Lin1, Hoi-Hung Chan1, Fong-Wei Tsay1, Kwok-Hung Lai12Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Published online:Oct 20, 2013
Article type:Research Article
Received:May 02, 2013
Accepted:Sep 27, 2013
How to Cite:Lin K, Yu H, Hsu P, Tsai W, Chen W, et al. Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy. Hepat Mon. 2013;13(10):11892. doi: https://doi.org/10.5812/hepatmon.11892
Abstract
Objectives:
To identify factors predicting virological relapse (VR) in CHC patients who attained RVR.
Patients and Methods:
Medical records of 133 CHC patients with an RVR after completing 24 weeks of antiviral therapy (a combination of pegylated interferon-? and ribavirin) were analyzed. Baseline characteristics and on-treatment responses were compared between the patients with an SVR and those with VR. Patients with normal alanine aminotransferase (ALT) levels at weeks 4 and 12 and at the end-of-treatment (EoT) and patients with elevated, but constantly decreasing, ALT levels were classified as having favorable patterns of ALT change. A trend of increasing ALT levels either between weeks 4 and 12 or between weeks 12 and EoT was classified as unfavorable. A high viral load (HVL) was defined as a baseline HCV RNA ? 600000 IU/mL.
Results:
In total, 116 (87.2%) patients had a SVR and 14 (10.5%) had VR. The VR rates were comparable between patients with genotype-1 (13.1%) and genotype-2 infection (8.7%) (P = 0.572). Multivariate analysis revealed that HVL (P = 0.015; odds ratio [OR] = 14.754; 95% confidence interval (CI) = 1.671130.240), and unfavorable ALT patterns (P = 0.039; OR = 4.397; 95% CI = 1.07817.930) independently predicted VR. In subgroup analysis, low viral load (LVL) patients had a minimal VR rate (1.8%). Among the HVL patients, the VR rate of those using peg-IFN-?-2a was relatively low (9.1%). Patients using peg-IFN-?-2b had a slightly higher VR rate (23.8%; P = 0.128), and patients with favorable patterns of ALT changes had a lower VR rate (10.3%) compared to the 53.8% in patients with unfavorable ALT patterns (P = 0.005).
Conclusions:
In southern Taiwan, 24 weeks of antiviral therapy achieved a high SVR rate in patients with CHC attaining RVR, except in the subgroup of patients treated with peg-IFN-?-2b with HVL and on-treatment unfavorable ALT patterns.
Copyright
© 2013, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.
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