Early viral response (EVR) is an important milestone of response-guided therapy for hepatitis C. However, there are different types of early response during the first 12 weeks, says Prof. Craxi.

Patients who become HCV RNA negative later have less chance to achieve a sustained viral response (SVR) due to greater likelihood for relapse (1-3). In patients with genotype 1 treated with PEG-IFN alpha 2a plus ribavirin, the rates of SVR achieved were found to be different between those who showed no EVR, rapid viral response (RVR), complete EVR (cEVR), or partial EVR (pEVR) (4). In genotype 1 patients with pEVR, a longer treatment duration of 72 weeks was found to work better (5).

RVR rates are higher in genotype 2 and 3 patients compared to genotype 1. In the ACCELERATE trial it was investigated whether shorter treatment duration is feasible in genotype 2 and 3 patients; 24 weeks of therapy was found to still be superior to 16 weeks in genotype 2 and 3 patients, and this difference may be due to viral load. Those with higher viral load over 800,000 IU/mL were found to have a greater difference in SVR rates at 16 versus 24 weeks of treatment with PEG-IFN alpha 2a plus ribavirin 800 mg/day (6).

Prof. Craxi provides a summary of treatment recommendations for genotype 1 and 2/3 patients, and discusses retreatment in non-responders; and treatment in special groups such as those with cirrhosis, transplanted patients, and HIV-infected patients.


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