Sustained virological responses following standard anti-viral therapy in decompensated HCV-infected cirrhotic patients
June 27th, 2009 Posted by: admin
Background Little data is available about predictors of sustained virological response (SVR) during anti-viral therapy of patients with decompensated HCV cirrhosis.Aims To determine whether rapid and early virological responses (RVR and EVR) could predict SVR and help optimize treatment in these patients.Methods A total of 94 cirrhotics underwent treatment with peg-interferon alfa-2b (1.5 [mu]g/kg weekly) and ribavirin (800/1200 mg daily) for 48 or 24 weeks for genotypes 1/4 or genotypes 2/3, respectively.Results Overall, SVR was achieved in 33 patients (35.1%), 16% with genotype 1/4 and 56.8% with genotype 2/3 (P < 0.01). At treatment week 4, 34 patients had undetectable HCV-RNA, 10 with genotype 1/4 and 24 with genotype 2/3. Of RVR patients, 24 achieved SVR (70.5%), 6 and 18 with genotypes 1 and non-1. At the multivariate analysis, only EVR, genotypes 2 and 3, and adherence to full course and dosage of therapy retained their independent predictive power, with corresponding ORs of 25.5 (95% CI 3.0[ndash]217.3), 4.2 (95% CI 1.2[ndash]15.3) and 9.1 (95% CI 2.2[ndash]38.0), respectively.Conclusion In decompensated cirrhotic patients, anti-viral therapy with current regimens is feasible and associated with an overall SVR rate of 35.1%. Treatment ought to be pursued among patients who attain an EVR, and maintain a full course and dosage of therapy.
