Genotype, Enzyme Levels, and Viral Load Are Clues to Hepatitis C Virus Outcomes

Researchers in Germany report that viral genotype and load, as well as liver enzyme levels, are predictors for treatment outcomes in chronic hepatitis C. Their multicenter, retrospective investigation examined the data for 260 patients in Europe who were treated with pegylated interferon alfa, or with standard interferon. The patients, who underwent therapy for 6-12 months, also received ribavirin.

"A viral load at treatment week four above 450,000 IU/mL and at week 12 above 30,000 IU/mL was 100 percent predictive for virologic nonresponse in all patients," reported Thomas Berg and colleagues of Humboldt University-Berlin. Statistical analysis indicated that being of HCV of genotypes 2 or 3, having high levels of alanine aminotransferase before starting treatment, and having a low viral load at baseline were independent predictors for attaining a sustained virologic response.

"None of the latter three factors were predictive for sustained virologic response when analysis was restricted to the subgroup of genotypes 2- and 3-infected patients," Berg and coauthors wrote. They suggested that by as early as 12 weeks after therapy has begun, doctors can determine whether or not sustained virological response will occur using a HCV RNA cut-off level 30,000 IU/mL. "This algorithm recognizes 53.7 percent of nonresponders previously identified at week 24 of treatment," they said.

The full study, "Prediction of Treatment Outcome in Patients with Chronic Hepatitis C: Significance of Baseline Parameters and Viral Dynamics During Therapy," was published in Hepatology (2003;37(3):600-609).

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