Archive for the ‘hepatitis С’ Category
Posted by James
Treatment of HCV using pegylated interferon and tablet ribavirin has clearly improved upon SVR rates compared to the older formulations. However, differences in racial responsiveness to therapy continue to be reported. There have been several trials that have attempted to address the question of discordant response to treatment among different races. Historically, Reddy et al. first noted that African Americans had a significantly lower response to interferon monotherapy compared with other racial groups (SVR rates 2% versus 12%), but this study only had a small cohort of African Americans compared with Caucasians. McHutchison et al. initially studied this question utilizing standard interferon monotherapy versus combination therapy. Their study concluded that the seemingly impaired responsiveness of African Americans compared to Caucasians could be overcome with the advent of combination therapy, and they reported that SVR rates were similar for African Americans and non-African Americans with genotype l. However, subsequent studies did not match this equality in responsiveness.
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Posted by James
Patient Demographics prior to Treatment
Table 1 outlines the baseline characteristics of our patient population, consisting of 73 individuals of multiethnic backgrounds who opted for therapy. This included 38 non-Hispanic Caucasians, 24 African Americans, three Hispanics, and eight Asian or Middle Easterners. There were a total of 50 patients who were genotype 1 and 23 patients who were nongenotype 1. The enrollment of the cohorts occurred concurrently, and the baseline characteristics of the groups were similar.
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Posted by James
Patient Selection
Patients were recruited from an open-access, university-based hepatology clinic over a 24-month period between 2001 and 2003. Patients with chronic hepatitis С were selected for treatment if they were treatment-naive, had clinically well-compensated liver disease with detectable HCV RNA levels present at baseline and genotype determination. Most genotype-1 patients had a liver biopsy performed within the 12 months prior to initiating treatment. Patients were excluded from therapy if there was evidence of decompensated liver disease or other relative or absolute contraindications to treatment. Patients who had evidence of coinfection with hepatitis В or HIV (Generic Retrovir is used for treating HIV infection) were not included in this study. All prospective patients were appropriately counseled regarding treatment side effects with pegylated interferon and drug ribavirin, the need to avoid pregnancy and the requirement for at least monthly laboratory and clinical evaluations as well as the need to maintain compliance with treatment to optimize therapeutic response. All were ultimately given the freedom to decide on treatment or expectant management. If the patient opted to not receive treatment, the reason for this decision was recorded.
Posted by James
INTRODUCTION
Hepatitis-C virus (HCV) is the most common cause of chronic liver disease and the most common indication for liver transplantation in the United States. Hepatitis С is more common in African Americans than Caucasians, with a seroprevalence of 3.2% in non-Hispanic African Americans and 1.5% in non-Hispanic Caucasians. In addition, 96% of African Americans with HCV have genotype-1 infections. The latest treatment option for chronic HCV includes combination pegylated interferon and generic ribavirin. The likelihood of a sustained virological response (SVR) to treatment, defined as an undetectable viral load six months after therapy, correlates with several clinical and viral factors, including age, genotype, histology and initial level of HCV RNA in serum. Recently completed trials of pegylated interferon and ribavirin treatment in chronic HCV report that patients with genotypes 2 and 3 have up to an 80% SVR, while those with genotype 1 have a 40% SVR overall.
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