Early changes in hepatitis C virus (HCV) RNA levels predict response to interferon treatment in noncirrhotic HCV patients.
The role of hepatitis C virus (HCV) RNA quantification in determining ideal interferon (IFN) treatment of noncirrhotic HCV liver disease is uncertain. The specific aim of this study was to determine whether measurement of baseline HCV RNA or changes in HCV RNA levels (DHCV RNA) early during therapy predict response to IFN alpha in noncirrhotic HCV patients.


METHODS
Twenty-one noncirrhotic patients with chronic HCV were treated with 3 MU IFN alpha-2a three times per week. HCV RNA levels were determined at baseline and after two, four, six, eight and 12 weeks of treatment. Baseline HCV RNA and DHCV RNA during therapy were compared with treatment response results at six months. Data were expressed as mean +/- SE, and differences were assessed using Student's t test.


RESULTS
Twenty-one patients initiated IFN alpha therapy. Two patients were noncompliant and lost to follow-up. One patient discontinued IFN alpha due to side effects. Apart from age, where responders tended to be younger than nonresponders, the baseline clinical characteristics and alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin and HCV RNA levels did not differ between IFN alpha responders and nonresponders. Levels of HCV RNA were significantly lower after both two and four weeks of therapy in IFN alpha responders compared with nonresponders (P<0.001). Changes in log HCV RNA levels after both two and four weeks of therapy were significantly greater in IFN alpha responders compared with nonresponders (P<0.001). Changes in log HCV RNA of more than 1.0 after two weeks of IFN alpha therapy identified all six-month responders, with a sensitivity of 100% and a specificity of 89%. Potential financial impact of these findings on patients' management was also calculated. Decisions regarding discontinuation of therapy based on early changes in HCV RNA levels would result in a 40% to 50% reduction in IFN alpha cost.


CONCLUSIONS
In noncirrhotic HCV patients, the change in quantitative HCV RNA after the first two weeks of IFN alpha therapy identifies responders. This finding would result in a 40% to 50% cost savings if decisions about continuing IFN alpha were based on early changes in HCV RNA levels rather than ALT or HCV RNA assessment after the completion of three months of IFN alpha treatment.
Liver Diseases Unit, University of Manitoba, Winnipeg, Canada.
G
G
Fallows
K
K
Kaita
G
G
Minuk
F
F
Penner
G
G
Smart
M
M
Dawood
B
B
Rosser
D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017046:Cost Savings; D005260:Female; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D012367:RNA, Viral / Q000378:metabolism*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D000410:Alanine Transaminase