Background  Rapid virological response (RVR) is the best predictor of sustained response to standard HCV treatment.

Aim  To evaluate predictive factors of RVR.

Methods  Sixty-five patients (mean age 52.6 ± 13.8; 37 genotype-1, and 28 genotypes-2/3) were consecutively treated with pegIFN-alpha2a or 2b once weekly plus daily ribavirin based on body weight for 24 or 48 weeks, according to genotype. RVR was defined as undetectable HCV-RNA at week 4.

Results  Twenty-seven percent of patients achieved RVR in genotypes 1 and 60.7% in genotypes 2/3 (< 0.01). Rapid responders had higher mean serum baseline total and LDL-cholesterol levels (< 0.01). RVR was 20.0% in the bottom tertile of total cholesterol and 63.6% in the top tertile (< 0.01). HCV-RNA levels at week 4 were positively correlated with baseline serum insulin (< 0.01), HOMA-IR (< 0.01), body mass index (< 0.05) and number of components of metabolic syndrome (< 0.01) and negatively correlated with cholesterol levels (< 0.05). At multivariate analysis, age, LDL-cholesterol, HCV genotype and serum 8-iso-PGF2alpha, a marker of oxidative stress, were independent predictors of RVR.

Conclusions  Our prospective study supports a role of low serum total and LDL-cholesterol and of oxidative stress as positive independent predictive factors of poor RVR in HCV patients.