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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Pre-treatment prediction of response to peginterferon plus ribavirin in chronic hepatitis C genotype 3
Sebastián Marciano, Silvia M Borzi, Melisa Dirchwolf, Ezequiel Ridruejo, Manuel Mendizabal, Fernando Bessone, María E Sirotinsky, Diego H Giunta, Julieta Trinks, Pablo A Olivera, Omar A Galdame, Marcelo O Silva, Hugo A Fainboim, Adrián C Gadano
Sebastián Marciano, Omar A Galdame, Adrián C Gadano, Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Silvia M Borzi, Hepatology Section, Hospital R. Rossi, La Plata, Buenos Aires, Argentina
Melisa Dirchwolf, Hugo A Fainboim, Liver Infectious Disease Unit, Hospital F.J Muñiz, Uspallata 2272, Buenos Aires, Argentina
Ezequiel Ridruejo, Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Avenida Galván 4102, Buenos Aires, Argentina
Ezequiel Ridruejo, Manuel Mendizabal, Marcelo O Silva, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Buenos Aires, Argentina
Fernando Bessone, Hepatology Unit, Sanatorio del Parque, Rosario, Argentina
María E Sirotinsky, HEPATOSUR group, Comodoro Rivadavia, Chubut, Argentina
Diego H Giunta, Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Julieta Trinks, Basic Science and Experimental Medicine Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Pablo A Olivera, Internal Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Buenos Aires, Argentina
Author contributions: Marciano S studied design, data acquisition, analyze the data, wrote the manuscript; Borzi SM, Dirchwolf M, Ridruejo E, Mendizabal M, Bessone F, Sirotinsky ME, Olivera PA, Galdame OA, Silva MO, Fainboim HA and Gadano AC contributed equally in data acquisition, concept design and reviewing of the manuscript; Giunta DH contributed to statistical analyses, concept design and reviewing of the manuscript; Trinks J processed INFL3 polimorfisms, conceived design and reviewed of the manuscript.
Ethics approval: The study was reviewed and approved by the Hospital Italiano de Buenos Aires Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflict of interest to declare.
Data sharing: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sebastián Marciano, MD, Liver Unit, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH Capital Federal, Buenos Aires, Argentina. sebastian.marciano@hospitalitaliano.org.ar
Telephone: +54-11-49590200-5370 Fax: +54-11-49590346
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: November 1, 2014
Revised: November 5, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 8, 2015
AIM: To evaluate pre-treatment factors associated with sustained virological response (SVR) in patients with hepatitis C virus (HCV) genotype 3 treated with peginterferon and ribavirin (RBV).
METHODS: We retrospectively analyzed treatment naive, mono-infected HCV genotype 3 patients treated with peginterferon and RBV. Exclusion criteria included presence of other liver disease, alcohol consumption and African American or Asian ethnicity. The variables collected and compared between patients who achieved an SVR and patients who did not were as follows: gender, age, fibrosis stage, diabetes, body mass index, steatosis, INFL3 polymorphism, pre-treatment HCV-RNA, type of peginterferon, RBV dose and adherence.
RESULTS: A total of 107 patients treated between June, 2004 and March, 2013 were included. Mean treatment duration was 25.1 (± 1.8) wk. Overall, 58% (62/107) of the patients achieved an SVR and 42% (45/107) did not. In the multivariate logistic regression analysis, pre-treatment HCV-RNA ≥ 600000 UI/mL (OR = 0.375, 95%CI: 0.153-0.919, P = 0.032) and advanced fibrosis (OR = 0.278, 95%CI: 0.113-0.684, P = 0.005) were significantly associated with low SVR rates. In patients with pre-treatment HCV-RNA ≥ 600000 UI/mL and advanced fibrosis, the probability of achieving an SVR was 29% (95%CI: 13.1-45.2). In patients with pre-treatment HCV-RNA < 600000 UI/mL and mild to moderate fibrosis, the probability of achieving an SVR was 81% (95%CI: 68.8-93.4).
CONCLUSION: In patients with HCV genotype 3 infections the presence of advance fibrosis and high pre-treatment viral load might be associated with poor response to peginterferon plus RBV. These patients could benefit the most from new direct antiviral agents-based regimes.
Core tip: Our study evaluates pre-treatment factors associated with sustained virological response in patients with hepatitis C virus genotype 3 treated with peginterferon plus ribavirin. We identified a sub-group of patients with high pre-treatment viral load and advanced fibrosis whose chance of achieving a sustained virological response is as low as 29%. We believe these patients should be prioritized to access new treatment strategies.
