Wednesday, April 25, 2012

How to manage genotype 2 and 3 non-responders and relapsers?

Nonresponders/relapsers infected with HCV G2/3
Genotype 2 or 3 infected patients are easier to treat and require
only 24 weeks of therapy with PegIFN and low-dose of RBV (800
mg/day) (Zeuzem 2004). Patients who are intolerant of a planned
24-week course of therapy can discontinue the antiviral therapy
between weeks 12 and 16 without a negative impact on SVR, if
they have achieved a RVR (Mangia 2005).
Treatment failure is uncommon in genotype 2 and 3 patients.
Primary non-response to PegIFN/RBV is a very rare event, while
partial response or virological relapse after therapy withdrawal
may be detected in a subgroup of patients. Factors that have
been associated with suboptimal response to SoC in HCV
genotypes 2/3 patients include hepatic steatosis, obesity and IR
(Zeuzem 2004, Poustchi 2008), advanced fibrosis (Dalgard 2004)
and high pretreatment viremia (Shiffman 2007).
In most clinical trials, SVR rates in patients with HCV genotype 2
or 3 chronic infection, considered as a single group, exceed 80%
Antiviral therapy in non-responders, relapsers and special populations | 51
(Zeuzem 2008). However, in a meta-analysis (Andriulli 2008), an
overall SVR rate of 80-89% for HCV genotype 2, but only 66-80%
for genotype 3 was reported, with an estimated 8.7% difference
in SVR rates between the two genotypes after a 24-week course
of PegIFN alfa-2b plus RBV. Reduced response in genotype 3 is
associated with a higher incidence and degree of steatosis and
higher rate of post-treatment relapse.

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