Trent hepatitis CSG. A comparison of the natural history and outcome of treatment for Asian and non-Asian hepatitis C-infected patients

Department of Hepatology, Royal Derby Hospital, Derby, UK
Journal of Viral Hepatitis (Impact Factor: 3.91). 06/2011; 18(7):e270 - e277. DOI: 10.1111/j.1365-2893.2010.01406.x


  Ethnicity is an important host variable, but its impact on disease progression and response to therapy in Hepatitis C infection is unclear. Here we compare the natural history and outcome of therapy in White and Asian (Indian subcontinent) Hepatitis C infected patients. A total of 2123 White and 120 Asian HCV infected patients were identified within the Trent HCV study. Response to therapy was assessed in 224 White and 46 Asian patients with genotype 3 infection who received Pegylated Interferon and Ribavirin. Asian patients were more likely to be older, female, infected with genotype 3 and to consume no alcohol. At time of first biopsy, fibrosis stage was significantly higher in Asian patients than in Whites (3.0 ± 2.3 vs 1.8 ± 2.0, P < 0.001), as were necro-inflammation and steatosis scores. However, in those patients where duration of infection could be estimated, fibrosis progression was similar for both groups (0.25 ± 0.31 vs 0.16 ± 0.54 Ishak points/year, P = 0.068). 78.3% of Asian and 67.9% of White genotype 3 patients had a sustained virological response following Pegylated Interferon and Ribavirin. Cirrhosis and increased levels of GGT, but not ethnicity were associated with a reduction in the likelihood of a sustained virological response on multivariate analysis. Asian patients with Hepatitis C are more likely to be female, less likely to give a history of risk factors, present to medical services at an older age, and have more severe liver disease at diagnosis, but disease progression and response to treatment are similar to White patients.

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    ABSTRACT: Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC). Successful HCV eradication can reduce the liver-related mortality and morbidity. Previous studies show that Asian HCV-1 patients tend to have higher sustained virologic response (SVR) rates than Caucasian, Hispanic or African-American HCV-1 patients. Recent genome-wide association studies (GWAS) reveal interleukin-28B (IL28B) genotypes at locus rs12979860 or rs8099917 are strong predictors for SVR in HCV-1 patients treated with peginterferon-α (PEG-IFN-α) plus ribavirin (RBV), and the higher frequencies of favorable IL28B genotype in Asian patients than those in other ethnicity may explain the superior response in Asian HCV-1 patients. However, the predictive role of IL28B genotype is limited for HCV-2 patients and for HCV patients with response-guided therapy. IL28B genotype still predicts SVR in patients with triple therapy by telaprevir (TVR) or boceprevir (BOC). For newer direct-acting antivirals (DAAs), its predictive role remains to be confirmed.
    Current Hepatitis Reports 09/2013; 12(3). DOI:10.1007/s11901-013-0176-4
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    ABSTRACT: There is much controversy surrounding the natural history of hepatitis C virus (HCV) infection. The aim of this review was to review the natural history of HCV infection. Published English literature was searched via pubmed and then reviewed. Approximately, 75-85% of HCV-infected persons will progress to chronic HCV infection. The rate of chronic HCV infection is affected by a person's age, gender, race, and viral immune response. Once chronic HCV infection develops, there are external and host factors that can increase the risk of progression of liver disease. Progression of chronic HCV infection is not linear in time, probably because many cofactors change the rate of development of fibrosis, cirrhosis, and hepatocellular carcinoma. Factors linked with aggressive disease progression include age at infection, duration of infection, heavy alcohol use, co-infections with HIV or hepatitis B virus, male sex, steatosis, insulin resistance (and factors associated with the metabolic syndrome), and host genetics. However, the relative importance of many and varied factors remains uncertain, and further research efforts should be directed toward design of predictive models for effective risk stratification. Interferon-based therapy, particularly among those achieving a sustained virologic response (SVR), is associated with improved fibrosis and inflammation scores, reduced incidence of hepatocellular carcinoma, and prolonged life expectancy. Despite the progress in understanding the factors affecting the natural history of HCV infection, a great deal remains to be learnt.
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