Trent hepatitis CSG. A comparison of the natural history and outcome of treatment for Asian and non-Asian hepatitis C-infected patients
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.
- [Show abstract] [Hide abstract] 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.0Comments 6Citations
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- [Show abstract] [Hide abstract] ABSTRACT: Identifying the impact of a patient's ethnicity on treatment responses in clinical practice may assist in providing individualized treatment regimens for chronic hepatitis C (CHC). The effectiveness of standard peginterferon plus ribavirin therapy and the need for triple combination therapy with protease inhibitors in Koreans remain matters of debate. These issues were investigated in the present study. The clinical data of 272 treatment-naïve Korean CHC patients who were treated in a community-based clinical trial (Clinical Trial group; n=51) and in clinical practice (Cohort group; n=221), were analyzed and compared. All were treated with standard protocols of peginterferon alfa-2a plus ribavirin therapy. For patients with hepatitis C virus (HCV) genotype 1, the sustained virological response (SVR) rates in the Clinical Trial and Cohort groups were 81% (21/26) and 55% (58/106), respectively, by intention-to-treat (ITT) analysis (P=0.02), and 100% (13/13) and 80% (32/40), respectively, in treatment-adherent patients (P=0.18). For patients with HCV genotype 2, the SVR rates in these two groups were 96% (24/25) and 88% (101/115), respectively, by ITT analysis (P=0.31). Adherence and treatment duration were independent predictors of SVR for genotypes 1 and 2, respectively (P<0.01 for each). Korean patients with CHC achieved high SVR rates with peginterferon alfa-2a plus ribavirin in both the clinical trial and clinical practice settings. Measures to raise adherence to standard therapy in clinical practice may improve the SVR rates in these patients as effectively as adding protease inhibitors, thus obviating the need for the latter.0Comments 3Citations