Treatment failure in chronic hepatitis C: Predictors other than viral kinetics

Shahid Sarwar, Shandana Tarique

Abstract
ABSTRACT
Objective
To determine variables, other than viral kinetics, associated with outcome in patients with chronic hepatitis C being treated with interferon and ribavirin therapy.
Patients and Methods
This retrospective analytical study was carried out at Hepatology clinic of Mayo Hospital Lahore and included 145 patients treated with interferon and ribavirin. Data regarding demographic characteristics, hematological and biochemical parameters and ultrasonographic findings before therapy were recorded. Type of therapy, duration, side effect profile and outcome of therapy were noted. Correlation of patient’s variables with outcome of therapy were analyzed using analysis of variance (ANOVA) and receiver operating characteristic (ROC) curve.
Results
Out of 145 patients, 37 had sustained viral response (SVR), 48 relapse and 58 were non-responders to interferon therapy. Variables associated with SVR were younger age, less time interval between diagnosis and start of interferon therapy, high platelet count, high serum albumin value and absence of coarse texture on ultrasound abdomen. Area under curve (AUC) for SVR were 0.271 for age, 0.52 for interval between diagnosis and start of therapy, 0.65 for serum albumin and 0.63 for platelet count. High negative predictive value for SVR was noted for time interval between diagnosis and interferon therapy more than 11 months (72.05%), serum albumin < 4 grams/dl (84.6%) and platelet count < 180 x 109/L (85.7%) but these variables had poor positive predictive value and specificity, thus making them a good indicator of treatment failure.
Conclusion
Longer interval between diagnosis and treatment, low serum albumin and low platelet count at start of interferon therapy is associated with treatment failure in chronic hepatitis C patients. (Rawal Med J 2010;35: ).
Key Words
Chronic hepatitis C, Interferon therapy, Non-responders, Relapse.
INTRODUCTION
Chronic hepatitis C can lead to decompensated liver disease and its catastrophic complications. Asymptomatic nature of disease at earlier stages results in delay in diagnosis and treatment. With introduction of interferon (IFN) therapy over last 2 decades, this infection is now amenable to treatment. Once ribavirin was added and later on with development of Pegylated interferon, sustained viral response (SVR) has increased up to 80% in patients with genotype 2 and 3.1 Comparatively lesser benefit is seen in other genotypes i.e. 1, 4, 5 and 6 and treatment duration recommended is also 1 year as compared to 6 months in genotype 2 and 3.2 Treatment options for non-responders or relapsers are either Pegylated interferon in those treated with standard IFN previously,3 consensus interferon or just follow up for those with failure with Pegylated IFN therapy.4
In order to reduce the possibility of treatment failure, new treatment guidelines have identified indicators of favorable response in the form of rapid viral response (RVR) i.e. negative polymera

Key words: Chronic hepatitis C, Interferon therapy, Non-responders, Relapse.

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