Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Journal of Viral Hepatitis

Early View (Articles online in advance of print)
Published Online: 8 Jun 2010
© 2010 Blackwell Publishing Ltd
C. Puoti 1 , G. Barbarini 2 , A. Picardi 3 , M. Romano 4 , A. Pellicelli 5 , A. Barlattani 6 , F. Mecenate 7 , R. Guarisco 1 , O. M. Costanza 8 , L. Spilabotti 1 , L. Bellis 1 , M. E. Bonaventura 9 , O. Dell' Unto 1 , M. G. Elmo 10 , A. M. Nicolini 1 , L. Nosotti 11 and F. Soccorsi 5 , on behalf of the Club Epatologico Ospedaliero (Hospital Liver Club, CLEO)

1 Department of Internal Medicine and Liver Unit, Marino Hospital, Rome ; 2 Department of Infectious Diseases, San Matteo Hospital, Pavia ; 3 Liver Unit, Campus Biomedico University ; 4 Liver Unit, Sandro Pertini Hospital ; 5 Liver Unit, San Camillo Hospital ; 6 Liver Unit, San Giacomo Hospital ; 7 Liver Unit, Villa Betania Hospital ; 8 Molecular Biology Unit, Marino General Hospital, Rome ; 9 Department of Infectious Diseases, Rieti Hospital, Rieti ; 10 Department of Mental Health, Local Health Centre RM- A ; and 11 Department of Preventive Medicine of Migration, San Gallicano Hospital, Rome, Italy

Correspondence to Claudio Puoti, MD, Department of Internal Medicine and Liver Unit, Marino General Hospital, Via XXIV Maggio 5, 00047 Marino, Rome, Italy.
E-mail: puoti@epatologia.org

KEYWORDS
HCV • normal ALT • peginterferon • rapid virological response • ribavirin • sustained virological response

ABSTRACT
Summary. Rapid virological response (RVR) is now considered the strongest predictor of sustained virological response (SVR) in patients with HCV undergoing antiviral treatment, and thus, shorter antiviral treatment for these patients has been suggested. However, no data exist on the predictive value of RVR in HCV carriers with normal ALT values. A total of 137 patients with persistently normal ALT treated with peginterferon alfa 2a and ribavirin were studied. Fifteen patients dropped out early because of side effects, and in 10 patients with HCV-1 treatment was discontinued because of lack of early virological response (EVR). RVR was observed in 68% of the patients (42% patients with HCV-1, 90% HCV-2 and 64% HCV-3). An end-of-treatment response was observed in 86% of the patients (68% HCV-1, 100% HCV-2 and 91% HCV-3). SVR was maintained in 91 patients (46% HCV-1, 97% HCV-2 and 82% HCV-3). Overall, 92% patients with rapid response did obtain HCV eradication vs only 38% of those without rapid response. HCV-1 patients with baseline HCV RNA <400 × 103 IU/mL were more likely to achieve RVR and SVR than those with higher HCV RNA levels. We conclude that patients with genotype 1 and normal ALT who achieve HCV RNA negativity at week 4 may have a higher probability of eradicating their infection. Because of the concomitant favourable demographic and virological features often found in this particular subset of patients, the duration of therapy in these people might be shortened in the case of RVR. Persistently normal alanine aminotransferase levels patients with genotype 2 or 3 have a high chance of achieving SVR, so retesting of HCV RNA during treatment may have no additional practical value in these subjects.

Received January 2010; accepted for publication February 2010

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1365-2893.2010.01319.x About DOI
 
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