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Early identification of achieving a sustained virological response in chronic hepatitis C patients without a rapid virological response

Authors

  • Chung-Feng Huang,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Occupational Medicine, Taiwan and
    3. Department of Graduate Institute of Medicine, Taiwan,
    4. Department of Internal Medicine, Kaohsiung Municipal Ta-Tong Hospital, Kaohsiung, Taiwan, and
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    • 1

      Chung-Feng Huang and Jeng-Fu Yang have equal contributions.

  • Jeng-Fu Yang,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Preventive Medicine, Kaohsiung Medical University Hospital, Taiwan,
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    • 1

      Chung-Feng Huang and Jeng-Fu Yang have equal contributions.

  • Jee-Fu Huang,

    1. Department of Graduate Institute of Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
    3. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan,
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  • Chia-Yen Dai,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Occupational Medicine, Taiwan and
    3. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Chang-Fu Chiu,

    1. Department of Internal Medicine, Paochien Hospital, Pintung, Taiwan
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  • Nai-Jen Hou,

    1. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Taiwan,
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  • Ming-Yen Hsieh,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
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  • Zu-Yau Lin,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Shinn-Cherng Chen,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Ming-Yuh Hsieh,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Liang-Yen Wang,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Wen-Yu Chang,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Wan-Long Chuang,

    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
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  • Ming-Lung Yu

    Corresponding author
    1. Hepatobiliary Division, Department of Internal Medicine, Taiwan,
    2. Department of Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Taiwan,
    3. Department of Internal Medicine, Kaohsiung Municipal Ta-Tong Hospital, Kaohsiung, Taiwan, and
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  • Conflict of interest: The authors have no financial or personal relationships with any other organization.

Professor Ming-Lung Yu, Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, no. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan. Email: fishya@ms14.hinet.net; fish6069@gmail.com

Abstract

Background and Aim:  A number of hepatitis C virus (HCV) patients without a rapid virological response (RVR) achieved a sustained virological response (SVR) with peginterferon-α-2a/ribavirin. The aim of this study was to identify factors associated with SVR in non-RVR patients.

Methods:  Baseline and on-treatment factors were used to explore the prognostic factors for SVR in 113 HCV genotype-1 (HCV-1) and 20 HCV-2 non-RVR patients in two randomized trials.

Results:  The SVR rate in HCV-1 patients with a complete early virological response (cEVR) and partial early virological response was 91.9% versus 45% (P < 0.001) and 21.4% versus 10% (P = 0.62), respectively, after 48 and 24 weeks of treatment. The SVR rate in HCV-2 patients with a cEVR was 90.9% versus 57.1% (P = 0.25), respectively, after 24 and 16 weeks of treatment. Multivariate analysis showed that cEVR and standard regimen were independently associated with SVR. Viral kinetic study revealed that HCV viral loads < 10 000 IU/mL at week 4 were the best predictor of cEVR for both HCV-1 and HCV-2 non-RVR patients with the accuracy of 81% and 95%, respectively, and also of SVR with the accuracy of 78% and 92%, respectively, in patients receiving standard of care. The most important independent predictors for cEVR were HCV viral loads < 104 IU/mL at week 4, followed by increased ribavirin dose within 12 weeks of treatment.

Conclusions:  Achieving a cEVR with standard of care is the most important predictor of SVR in non-RVR patients. Week 4 viral loads < 10 000 IU/mL could accurately predict cEVR early and following SVR in non-SVR patients.

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