Predictors of Sustained Virological Response to Pegylated Interferon/Ribavirin Therapy in Chronic Hepatitis C Infected Egyptian Patients in the Northeast Provinence
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Predictors of Sustained Virological Response to Pegylated Interferon/Ribavirin Therapy in Chronic Hepatitis C Infected Egyptian Patients in the Northeast Provinence,KHALIL A. KHALIL, MOHAMED F. HASSAN, NADER A. MOHAMED and RYIAD A. MOHAMED
Abstract
In Egypt, the prevalence rate of HCV antibody positivity has been estimated to be between 10-13%. Although patients with genotype 4 infection have traditionally been deemed 'difficult-to-treat', data related to treatment response in this patient population are limited and sometimes conflicting. The global standard combination therapy regimen using pegylated interferon (PEG-IFN) with ribavirin (RBV) used for viral; eradication, with sustained virological response (SVR) rates ranging from 66 to 80%.
Aim of the Study: To determine predictors of SVR to combination antiviral therapy in order to improve treatment outcome and to diminish the adverse effects of treatment in CHC infected patients.
Patients and Methods: A retrospective cohort study was conducted to include all patients (529 patients) with chronic naïve HCV infection treated with combination therapy (PEG-IFN/RBV) for 48 weeks and 24 weeks of follow-up (72 weeks). The predictors of response of pre-enrollment investi-gations and adverse events were documented at five main phases; at +0wks (baseline), +12 wks (EVR), +24 wks, +48 wks (ETR), and at +72 wks (SVR) in Ismailia Viral Hepatitis Center in the Northeastern provinence.
Results: The frequency of responders among male gender (75.7%) was significantly higher compared to responders among females (24.3%) (p<0.0001). The responder patients showed lighter body weights than that of non-responders (80.19±11.70 vs. 83.9±14.37kg, respectively (p-value=0.002). The main predictors among responders compared to non-responders at baseline prior to initiation of therapy showed higher mean of albumin (4.4±0.3 vs. 4.3±0.6gm/dl) and hemoglobin levels (15.28±1.8 vs. 14.1±1.7) (p=0.029 and p<0.0001, respectively). However, multiple univariate predictor factors showed significantly higher levels of: Total bilirubin, PT%, alkaline phosphatase, TSH, AFP, and Shistosomal Abs among non-responders compared to responders at baseline assessment (p=<0.0001, <0.0001, 0.037, <0.0001, 0.0045, <0.0001 and <0.0001, respectively). The frequency of responders with low viral load (£400x103 IU/ml) (50.9%) was signif-icantly higher than the frequency of non-responders (40.5%). The frequency of low pathological stage was higher signifi-cantly among responders (72.5%) than in non-responders (60.5%) (p<0.01). The frequency of responders treated with interferon a-2a (66.8%) was significantly higher than the frequency of responders treated with interferon a-2b (33.2%) (p<0.01) among all treated CHC patients (n=529) receiving combination therapy (PEG-IFN/RBV).
Conclusions: Predictors of SVR to antiviral therapy in the Egyptian CHC patients include male gender, lighter body weight, higher mean albumin, hemoglobin and lower mean alkaline phosphatase, total bilirubin, total leucocytes count, PT%, TSH, AFP, shistosomal Abs, interferon a-2a, low viral load and low pathological stage.