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Viral Load Research
2009
2009
HCV Viral Load Decline during First 48 Hours of Pegylated Interferon plus Ribavirin in HCV Monoinfected and HCV/HIV Coinfected Patients
Dec 4
http://www.hivandhepatitis.com/hep_c/news/2009/120409_a.html
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By Liz Highleyman
During treatment with pegylated interferon plus ribavirin, plasma HCV RNA decreases with a rapid first phase and a slower second phase, the study authors noted as background.
In this analysis, the researchers compared the magnitude (size) and slope (speed or rate) of viral load decline during the first 48 hours of treatment with pegylated interferon alfa-2a (Pegasys) plus ribavirin in patients who did and did not achieve RVR, defined as undetectable HCV RNA (< 50 IU/mL) at week 4.
The study
included 23 patients with genotype 1 or 4 HCV (14 monoinfected and 9 HIV/HCV
coinfected). Plasma HCV RNA was measured at baseline, at 48 hours, and at weeks
1, 2, 4, 8, 12, 48, and 72. HCV viral load decrease, slope of the decrease, and
the efficiency factor (epsilon) were determined in the first 48 hours after the
start of therapy.
Results
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5 HCV monoinfected participants (36%) and 3 HIV/HCV coinfected patients (33%) attained RVR at week 4. | ||||
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6 monoinfected patients (43%) and 5 coinfected patients (56%) achieved SVR at 24 weeks after completion of therapy. | ||||
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The 5 HCV monoinfected participants who attained RVR demonstrated both a larger decrease in HCV viral load and a steeper slope (faster decline) compared to the 9 monoinfected patients without RVR. | ||||
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Among the coinfected participants, however, a significant association between HCV RNA decline at 48 hours and RVR was not observed. | ||||
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When looking at participants who achieved SVR, larger HCV RNA decline and steeper slope at 48 hours were seen in both HCV monoinfected and HIV/HCV coinfected patients. |
Based on these findings, the study authors concluded, "in the first 48 hours
after the start of therapy, HCV monoinfected patients with an RVR have a larger
viral load decrease, steeper viral slope, and a higher efficiency factor as
compared with non-RVR patients."
Early response at week 12 is commonly used to decide whether patients can stop interferon-based treatment that is unlikely to produce a sustained response. Numerous studies have shown that RVR at week 4 is also a good predictor of SVR. This study suggests that even very early response at 48 hours may be a predictive factor, at least among HCV monoinfected patients.
Departments of Internal Medicine and Infectious Diseases, Medical Microbiology, Gastroenterology, and Immunology, University Medical Center Utrecht, Utrecht, Netherlands; Department of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands; Department of Internal Medicine and Infectious Diseases, Erasmus Medical Center, Rotterdam, Netherlands.
12/4/09
Reference
JE Arends, JC Stuart, LC Baak, and others. Plasma HCV-RNA decline in the
first 48 h identifies hepatitis C virus mono-infected but not HCV/HIV-coinfected
patients with an undetectable HCV viral load at week 4 of peginterferon-alfa-2a/ribavirin
therapy. Journal of Viral Hepatitis 16(12): 867-875. December 2009. (Abstract).
Treatment Response in Older Patients
Higher baseline viral load, lower ALT ratio, and liver cirrhosis also predicted poorer response in older patients.
http://www.hcvadvocate.org/news/newsRev/2009/HJR-6.11.html
Dec 1 09
Response to interferon-based therapy in older individuals is an important issue,
as the average age of chronic hepatitis C patients is rising and the risk of
advanced liver disease increases with longer duration of infection. In a study
described in the October 2009 Journal of Viral Hepatitis, K.R. Reddy
and colleagues analyzed data from 569 patients with chronic genotype 1 HCV
infection enrolled in two randomized Phase III studies of 180 mcg/week pegylated
interferon alfa-2a (Pegasys) plus 1000-1200 mg/day weight-adjusted ribavirin for
48 weeks.
The investigators found that patients older than 50 years had a significantly lower sustained virological response (SVR) rate 24 weeks after completing therapy compared with those age 50 or younger (39% vs. 52%, respectively; P = 0.0073). However, older patients who achieved rapid virological response (undetectable HCV RNA at week 4 of treatment) or complete early virological response (detectable HCV RNA at week 4 but < 50 IU/mL at week 12) had high SVR rates (83% and 61%, respectively).
Overall, the older group had a significantly higher relapse rate compared with the younger patients (41% vs. 25%, respectively; P = 0.0042). Older patients were found to have lower cumulative pegylated interferon and ribavirin blood concentrations¾despite being prescribed the same doses¾and low drug levels predicted failure to achieve SVR. The researchers suggested that more frequent ribavirin dose reductions among the older patients likely contributed to the higher relapse rate. Higher baseline viral load, lower ALT ratio, and liver cirrhosis also predicted poorer response in older patients.
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2005-2004
Oct 2005
Viral Load Measurements in Hep C with Antiviral Therapy
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Is There a Correlation Between HCV Viral Load and Severity of Liver Disease?
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Viral Load not Dependent on Genotype
Viral Load may not be Linked to Liver Damage
Viral Load in the First 24 Hours of Treatment
Viral Load in 12 Weeks of Treatment
Viral Load per Liver cell Before Treatment
Increase in HCV Viral Load After Interferon Therapy
Viral Load Measurements in Hep C with Antiviral Therapy
Is There a Correlation Between HCV Viral Load and Severity of Liver Disease?
Spontaneous Fluctuations in Viral Load (Untreated)
Viral Load not Dependent on Genotype
Viral Load may not be Linked to Liver Damage
Viral Load in the First 24 Hours of Treatment
Viral Load in 12 Weeks of Treatment
Viral Load per Liver cell Before Treatment
Increase in HCV Viral Load After Interferon Therapy