Viral response guided therapy for hepatitis C in the approaching era of direct acting anti-viral agents.

摘要

Response guided therapy involving the individualization of therapy based on viral responses during the first 12 weeks of treatment is common practice nowadays in patients with chronic hepatitis C virus (HCV) treated with peginterferon plus ribavirin. Indeed, all key published practice guidelines use an early virological response (EVR), defined as at least a two log reduction in HCV RNA or HCV RNA negatherapytive at week 12, as the primary demarcation point for ongoing . If an EVR is not achieved at 12 weeks, a sustained virological response (SVR) 6 months following completion of therapy is highly unlikely and treatment is typically discontinued. In comparison, patients who achieve an EVR at week 12 have a 65% chance of achieving an SVR.3'4 The rapidity of the virological response achieved at week 12 is also a key determinant of treatment outcome. A complete EVR, defined as HCV RNA positive at week 4 with undetectable HCV RNA at week 12, is associated with a 60% SVR rate, while a partial EVR, defined as detectable HCV RNA at week 12 but with >= two log-10 decrease from baseline in HCV RNA, is associated with as low as a 20% SVR rate.