Citation Information :
Kaur D, Chhina RS, Goyal O, Goyal P. Treatment results and factors affecting sustained virological response in chronic hepatitis C patients in Northern India. J Gastrointest Infect 2015; 5 (1):24-30.
Background and Objectives: Chronic hepatitis C (CHC) is a major cause of liver-related morbidity and mortality. Data on the treatment outcomes of CHC with pegylated interferon plus ribavirin (PEG-RBV) in Indian patients are limited. This study aimed to evaluate the efficacy, safety and factors associated with sustained virological response (SVR) in CHC patients treated with PEG-RBV in northern India.
Materials and Methods: Consecutive treatment naïve patients with CHC infection treated with PEG-RBV combination therapy between January 2011 and December 2014 were included. Patients with cirrhosis and other contraindications were excluded.
Results: Of the total 108 patients enrolled, 102 (94.4%) patients completed the treatment (mean age- 43 ±12.7 years; 62% males). The mean BMI was 23.9 ± 4.2 and mean ALT was 85.7 ± 68 IU/L. HCV viral load >4,00,000 IU/ml was present in 45.4%. The most common genotype was 3 (69.4%; n=75), followed by genotype 1 (26.8%; n=29) and genotype 4 (3.7%; n=4). By intention-to-treat analysis, the overall SVR rate was 94.4% (102/108). In genotype 1 patients it was 86.2% (25/29) and 98.7% (74/75) (p=02) in genotype 3 patients. On multivariate analysis, non-genotype 3 infection predicted lower SVR.
Interpretation and Conclusions: SVR rates in CHC patients treated in northern India with PEG-RBV therapy in our study (86.2% for genotype 1 and 98.7% in genotype 3) were better than those reported in western and other Indian studies. Better patient compliance, better monitoring and better management of adverse events lead to superior treatment outcomes.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol. 2011;55:245-64.
Sood A, Sarin SK, Midha V, Hissar S, Sood N, Bansal P, Bansal M. Prevalence of hepatitis C virus in a selected geographical area of northern India: a population based survey. Indian J Gastroenterol. 2012;31:232-6.
Sood A, Midha V, Goyal O, Goyal P, Sood N, Sharma SK. Profile of hepatocellular carcinoma in a tertiary care hospital in Punjab (northern India). Indian J Gastroenterol. 2014;33:35-40.
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis virus infection. N Eng J Med. 2002;347:975-82.
Hadziyannis SJ, Sette H, Morgan TR. Peginterferon alfa-2a (40 kilodaltons) and ribavirin combination therapy in chronic hepatitis C: randomized study of the effect of treatment duration and ribavirin dose. Ann Intern Med. 2004;140:346-55.
Zeuzem S. Heterogeneous virologic response rates to interferon based therapy in patients with chronic hepatitis C: who respond less well? Ann Intern Med. 2004;140:370-81.
Borroni G, Andreoletti M, Casiraghi MA, Ceriani R, Guerzoni P, Omazzi B et al. Effectiveness of pegylated interferon/ribavirin combination in 'real world' patients with chronic hepatitis C virus infection. Aliment Pharmacol Ther. 2008;27:790-7.
Sood A, Midha V, Goyal O, Hissar S, Sharma SK, Khanna P. Treatment of chronic hepatitis C with pegylated interferon plus ribavirin in treatment-naïve 'real-life' patients in India. Indian J Gastroenterol. 2014;33:343-9.
Alexopouloua A, Karayiannisb P. Interferon-based combination treatment for chronic hepatitis C in the era of direct acting antivirals. Annals of Gastroenterology. 2015;28:55-65.
EASL recommendations on treatment of hepatitis C 2014. J Hepatol. 2014;61:373-95.
Tohra SK, Taneja S, Ghosh S, Sharma BK, Duseja A, Dhiman RK et al. Prediction of sustained virological response to combination therapy with pegylated interferon alfa and ribavirin in patients with genotype 3 chronic hepatitis C. Dig Dis Sci. 2011;56:2449-55.
Ray G, Pal S, Nayyar I, Dey S. Efficacy and tolerability of pegylated interferon alpha 2b and ribavirin in chronic hepatitis C- a report from eastern India. Trop Gastroenterol. 2007;28:109- 12.
Gupta R, Ramakrishna CH, Lakhtakia S, Tandan M, Banerjee R, Reddy DN. Efficacy of low dose peginterferon alpha-2b with ribavirin on chronic hepatitis C. World J Gastroenterol. 2006;12:5554-6.
Aspinall RJ, Pockros PJ. Review article: the management of side effects during therapy for hepatitis C. Aliment Pharmacol Ther. 2004;20:917-29.
Sood A, Midha V, Goyal O. Genotypic distribution and associated disease pattern of hepatitis C virus in northern India. J Gastrointest Infect. 2014;4:40-3.
Ridruejo E, Adrover R, Cocozzella D, Fernández N, Reggiardo MV. Efficacy, tolerability and safety in the treatment of chronic hepatitis C with combination of PEG-Interferon - Ribavirin in daily practice. Ann Hepatol. 2010;9:46-51.
Gidding HF, Law MG, Amin J, Ostapowicz G, Weltman M, Macdonald GA et al. Hepatitis C treatment outcomes in Australian clinics. Med J Aust. 2012;196:633-7.
Missiha S, Heathcote J, Arenovich T, Khan K. Impact of Asian race on response to combination therapy with peginterferon alfa-2a and ribavirin in chronic hepatitis C. Am J Gastroenterol. 2007;102:2181-8.
Yan KK, Guirgis M, Dinh T, George J, Dev A, Lee A et al. Treatment responses in Asians and Caucasians with chronic hepatitis C infection. World J Gastroenterol. 2008;14:3416-20.
Sharafi H, Alavian SM. IL28B polymorphism, explanation for different responses to therapy in Hepatitis C patients. Hepat Mon. 2011;11:958-9.
Manns M, McHutchinson J, Gordon SC, Rustgi VK, Shiffman M, Reindollar R et al. Peg-interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001;358:958-65.