Sustained Virologic Response to Antiviral Therapy for Chronic Hepatitis C Virus Infection: A Cure and So Much More

Center for Hepatitis C, Atlanta Medical Center, Atlanta, Georgia 30312, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 04/2011; 52(7):889-900. DOI: 10.1093/cid/cir076
Source: PubMed


Sustained virologic response (SVR) is defined as aviremia 24 weeks after completion of antiviral therapy for chronic hepatitis C virus (HCV) infection. In analyses of SVR durability, the incidence of late relapse is extremely low (<1%). Histologic regression of both necroinflammation and fibrosis has been demonstrated in paired liver biopsy samples in SVR-achieving patients. More noteworthy is the sustained responder's favorable prognosis even with baseline cirrhosis; despite mostly retrospective analyses, relative to nonresponders or to those untreated, patients with SVR have significantly fewer liver-related complications, less hepatocellular carcinoma, and fewer liver-related deaths. Although HCV is associated with insulin resistance, successful eradication of HCV appears to reduce the risk of impaired fasting glucose and diabetes development. In summary, chronic HCV infection is curable with SVR attainment, and with cure comes improved liver histology and more favorable clinical outcomes, in comparison with patients who do not achieve the same therapeutic milestone.

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    • "Following the presentation of the potential utility of interferon-alfa (IFNa) for treating chronic non-A non-B hepatitis in 1986 [7], this agent became the mainstay of therapy for HCV [8] [9] [10] [11]. Over time the modification of IFNa to pegylated forms (PegIFNa) and the addition of ribavirin (RBV) improved rates of viral clearance 24 weeks post-treatment (sustained virologic response 24 [SVR24]) from 17% overall to approximately 40–50% in genotype (GT) 1 and 70–90% in GT 2 and 3 mono-infected patients [12]. "
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    ABSTRACT: Evidence over the past decades have shown that HIV/HCV coinfected patients did not respond as well to HCV therapy as HCV mono-infected patients. However, these paradigms are being recently reassessed with the improvements of care for HIV and HCV patients. This article reviews these original paradigms and how the new data is impacting upon them. Treatment efficacy now appears comparable for HIV/HCV coinfected and HCV mono-infected patients, while liver fibrosis progression is increasingly similar in optimally managed patients. Additional importance of therapy is directed to drug-drug interactions and the impact of HCV reinfection, as well as the possibility of transmitted drug resistance.
    Journal of Hepatology 08/2015; 345(5). DOI:10.1016/j.jhep.2015.06.034 · 11.34 Impact Factor
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    • "The aims of HCV treatment are to alleviate liver fibrosis, reduce transaminase levels, prevent hepatocellular carcinoma, improve the patient's quality of life and knock down the HCV viral load, helping to prevent the dissemination of the disease by reducing the number of people who can transmit it (Pearlman and Traub, 2011). Before HCV treatment , it is recommended that the oral health of the patients be evaluated. "
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    ABSTRACT: Hepatitis C virus (HCV) infection is a worldwide health problem, affecting over 130 million individuals. The virus is transmitted parenterally, making health care professionals a risk group for infection. For this reason it is important that dental health-care workers recognise the symptoms of the infection, which can be present in the oral cavities of hepatitis C-infected individuals. Moreover, dental health-care workers should know how to manage hepatitis C-infected individuals during dental treatment and the measures to prevent nosocomial spread of HCV. Thus, the purpose of this study was to perform a review of HCV epidemiology, natural history, transmission, diagnosis, treatment and prevention focusing on oral manifestations in and dental management strategies for HCV-infected individuals.
    Oral health & preventive dentistry 06/2014; 12(4). DOI:10.3290/j.ohpd.a32134 · 0.51 Impact Factor
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    • "The late virological relapse seen after PEG-IFN/RBV therapy emphasizes the importance of post-treatment monitoring. Late relapse is rare (<1%) following SVR at 24 weeks post-treatment (SVR24) and achievement SVR24 is generally regarded as a ‘cure’ following IFN-based therapy, associated with improvements in liver histology, liver-related morbidity and mortality [17]. There has been support for using 12 week post-treatment response to indicate SVR, and the Federal Drug Agency (FDA) now recommends use of SVR12 as the primary end point for HCV clinical trials [5,18,19]. "
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    ABSTRACT: Case-controlled studies have clearly demonstrated a link between chronic hepatitis C infection (CHC) and B cell non-Hodgkin lymphoma (NHL). To our knowledge, this is the first case report of outcome in a patient with CLL and chronic HCV infection treated with PEG-IFN/RBV and subsequent retreated with triple therapy. We report the case of a 54-year old, caucasian woman with a history of elevated liver enzymes diagnosed with chronic lymphocytic leukaemia (CLL) detected during investigation for hepatitis C (HCV) infection. The patient showed a haematological response following initially successful anti-HCV therapy with peginterferon plus ribavirin (PEG-IFN/RBV), with normalization of leukocyte and lymphocyte counts. She subsequently showed a late virological relapse at week 24, and was successfully retreated with telaprevir-based triple therapy. Despite an increase in leucocyte and lymphocyte count compared to baseline following triple therapy, to date there is no evidence of progression of CLL and the patient remains asymptomatic. Patients with CLL may experience haematological response following successful anti-HCV therapy using IFN-based regimens. Re-treatment with triple therapy including telaprevir following late virological relapse was successful, was not associated with any unexpected safety issues, and did not adversely affect CLL status.
    Infectious Agents and Cancer 03/2014; 9(1):10. DOI:10.1186/1750-9378-9-10 · 2.36 Impact Factor
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