CMAJ • July 4, 2006; 175 (1). doi:10.1503/cmaj.1060092.
© 2006 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Hepatitis C: reviewing the options

Michal R. Pijak

Consultant in Internal Medicine, Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, University Hospital, Bratislava, Slovakia

As Tom Wong and Samuel Lee mention in their article about hepatitis C,1 patients with genotype 2 or 3 "are expected to have a high likelihood of treatment success"; however, the conclusion that these patients "may not require a liver biopsy and do not require a baseline viral load measurement" seems premature.

First, several clinical trials2,3 have demonstrated a lower likelihood of sustained virological response in patients with genotype 2 or 3 who also have advanced fibrosis. Other researchers were unable to reproduce these findings, probably because such patients are often underrepresented in clinical trials.4 Additional studies are now showing that steatosis is another independent predictor of sustained virological response in these patients.4,5 Interestingly, findings in patients with genotype 3 indicate that only metabolic (but not viral) steatosis is associated with lower sustained virological response.6

Second, current evidence suggests that among patients with genotype 3, viral load is an important predictor of both sustained virological response3,4,7,8 and early virological response.3 Moreover, for patients with genotype 2 or 3 and early virological response at week 4, shorter courses of therapy (12–16 weeks) were as effective as the recommended course of 24 weeks.3,7,8 Whether patients with genotype 2 or 3 who have a high viral load and/or absence of early virological response (with or without advanced liver fibrosis) will benefit from longer treatment should be investigated in further clinical trials.

It therefore appears that both baseline histologic findings and viral load may be useful for tailoring treatment in certain subgroups of patients with genotype 2 or 3 in whom the standard duration of therapy might constitute overtreatment.

Footnotes

Competing interests: Dr. Pijak has received speaker fees and travel assistance from Hoffmann-La Roche and Schering-Plough.


REFERENCES

  1. Wong T, Lee SS. Hepatitis C: a review for primary care physicians. CMAJ 2006;174(5):649-59.[Abstract/Free Full Text]
  2. Poynard T, McHutchison J, Goodman Z, et al. Is an "a la carte" combination interferon alfa-2b plus ribavirin regimen possible for the first line treatment in patients with chronic hepatitis C? The ALGOVIRC Project Group [published erratum appears in Hepatology 2000; 32:446]. Hepatology 2000;31:211-8.[CrossRef]
  3. Dalgard O, Bjoro K, Hellum KB, et al. Treatment with pegylated interferon and ribavarin in HCV infection with genotype 2 or 3 for 14 weeks: a pilot study. Hepatology 2004;40:1260-5.[CrossRef][Medline]
  4. Zeuzem S, Hultcrantz R, Bourliere M, et al. Peginterferon alfa-2b plus ribavirin for treatment of chronic hepatitis C in previously untreated patients with HCV genotypes 2 or 3. J Hepatol 2004;40:993-9.[CrossRef][Medline]
  5. Harrison SA, Brunt EM, Qazi RA, et al. Effect of significant histologic steatosis or steatohepatitis on response to antiviral therapy in patients with chronic hepatitis C. Clin Gastroenterol Hepatol2005;3:604-9.[CrossRef][Medline]
  6. Poynard T, Ratziu V, McHutchison J, et al. Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology 2003;38:75-85.[CrossRef][Medline]
  7. von Wagner M, Huber M, Berg T, et al. Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology 2005;129:522-7.[CrossRef][Medline]
  8. Mangia A, Santoro R, Minerva N, et al. Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3. N Engl J Med 2005;352: 2609-17.[Abstract/Free Full Text]




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