Thyroid disease is a favorable prognostic factor in achieving sustained virologic response in chronic hepatitis C undergoing combination therapy: A nested case control study

<p>Abstract</p> <p>Background</p> <p>Interferon-α in combination with ribavirin is the current gold standard for treatment of chronic hepatitis C. It is unknown if the development of autoimmune thyroid disease (TD) during treatment confers an improved chance of achieving sustained virologic response. The aim of this study is to assess the chance of achieving sustained virologic response (SVR) in patients who developed TD during treatment when compared with those who did not.</p> <p>Methods</p> <p>We performed a tertiary hospital-based retrospective nested case-control analysis of 19 patients treated for hepatitis C who developed thyroid disease, and 76 controls (matched for age, weight, gender, cirrhosis and aminotransferase levels) who did not develop TD during treatment. Multivariate logistic-regression models were used to compare cases and controls.</p> <p>Results</p> <p>The development of TD was associated with a high likelihood of achieving SVR (odds ratio, 6.0; 95% confidence interval, 1.5 to 24.6) for the pooled group containing all genotypes. The likelihood of achieving SVR was increased in individuals with genotype 1 HCV infection who developed TD (odds ratio, 5.2; 95% confidence interval, 1.2 to 22.3), and all genotype 3 patients who developed TD achieved SVR.</p> <p>Conclusions</p> <p>Development of TD during treatment for hepatitis C infection is associated with a significantly increased chance of achieving SVR. The pathophysiogical mechanisms for this observation remain to be determined.</p> <p>Trial Registration</p> <p><it>The Australian New Zealand Clinical Trials Registry (ANZCTR)</it>: <a href="http://www.anzctr.org.au/ACTRB12610000830099.aspx">ACTRB12610000830099</a></p

Interferon in the treatment of chronic hepatitis C : a drug caught between past and future

INTRODUCTION: Chronic hepatitis C affects 2.2 - 3% of the world population (130 million - 170 million). Pegylated IFN-\u3b1 in combination with ribavirin, the currently approved therapy, leads to viral eradication in about 50% of treated patients, nevertheless it is associated with not negligible adverse events. Continuous efforts are being applied to improve the efficacy by means of new interferon molecules. Consensus IFN-\u3b1 is currently available for use, while albumin-interferon, IFN-\u3bb and IFN-\u3c9 are under investigation. Research is focussed on the directly acting antivirals, such as telaprevir and boceprevir, which are anticipated to enter the drug market during the next few years. AREAS COVERED: This paper reviews the classification of interferons, mechanism of action, pegylated IFN-\u3b1 molecules and their differences, current chronic hepatitis C treatment regimen and new drugs for HCV treatment. EXPERT OPINION: Pegylated IFN-\u3b1 will remain the basis of anti-HCV therapy during the next decade, since new IFN formulation are not proven to be superior or are in early stages of development and directly acting antivirals show limited antiviral activity as monotherap

Predictive Value of Complete and Partial Early Virological Response on Sustained Virological Response Rates of Genotype-4 Chronic Hepatitis C Patients Treated with PEG-Interferon plus Ribavirin

&lt;i&gt;Objectives:&lt;/i&gt; To investigate early viral kinetics, sustained virological response (SVR) rates and their predictors, in treatment-naïve, genotype-4-infected, chronic hepatitis C (CHC) patients treated with PEG-IFNα2b plus ribavirin. &lt;i&gt;Patients and Methods:&lt;/i&gt; In total, 58 patients were retrospectively analyzed. Early virological response (EVR) was defined as undetectable HCV-RNA (&lt;50 IU/ml) at week 12 (complete, cEVR) or at least a 2 log decrease in HCV-RNA levels (partial, pEVR). &lt;i&gt;Results:&lt;/i&gt; Thirty-one patients exhibited SVR (53.4%), 17 (29.3%) were non-responders and 10 (17.2%) relapsed. Thirty-seven patients (63.8%) exhibited EVR. The positive predictive values of EVR, cEVR and pEVR for the SVR achievement were 83.87, 54.83, and 29.03%, whereas their negative predictive values were 59.25, 77.77, and 81.48%, respectively. Both cEVR (OR 0.040, p = 0.042) and EVR (OR 0.016, p = 0.006) independently predicted SVR. Baseline viral load (p &lt; 0.001), age (p = 0.035) and stage of liver disease (p = 0.04) were significantly related to the EVR achievement, whereas only baseline viral load (p = 0.003) and ethnicity (p = 0.025) predicted cEVR. &lt;i&gt;Conclusions:&lt;/i&gt; Partial or complete EVR represent independent predictors of SVR in genotype-4-infected CHC patients, regardless of their baseline parameters. The absence of pEVR, rather than the absence of cEVR, should be used as an early indication for discontinuation of treatment in these patients.</jats:p

Hepatitis B markers and vaccination-induced protection rate among Albanian pregnant women in Greece

Hepatitis B has long been a serious public health problem both in Greece and in Albania. In the February 2009 issue of World Journal of Gastroenterology, Resuli et al presented the interesting epidemiological data concerning hepatitis B virus infection in Albania. The results of this study were discussed and several data from our similar research were provided. © 2009 The WJG Press and Baishideng. All rights reserved

Does interferon therapy prevent hepatocellular carcinoma in patients with chronic viral hepatitis?

Chronic hepatitis C and B are well-recognized and potentially preventable risk factors for hepatocellular carcinoma (HCC) development. Clinical and epidemiological studies suggest that therapy with interferon-\u3b1 may reduce the overall risk of HCC development in patients with chronic hepatitis C, who achieve sustained virological response, but even in those who fail to eradicate the infection. In chronic hepatitis B, interferon therapy reduces the risk of HCC development in HBeAg-positive and cirrhotic patients who achieve persistent suppression of viral replication, while in HBeAg-negative patients the beneficial effect of interferon-\u3b1 is not definitively confirmed. The preventive role of interferon-\u3b1 after potentially curative treatment for HCC in both chronic hepatitis B and C is uncertain due to methodological flaws of the existing studies and prospective randomized controlled trials with pegylated interferon-\u3b1 are needed to clarify this issue