Peginterferon plus ribavirin and sustained virological response rate in HCV-related advanced fibrosis: a real life study.
BACKGROUND
Tolerance and response to antiviral HCV treatment is poor in advanced fibrosis. The aim of this study was to assess SVR rate and its predictive factors in HCV advanced fibrosis patients treated in real life with full dose PEG-IFN plus RBV and to evaluate the adverse events related to treatment.


METHODS
A multicentric, retrospective study was conducted at six university hospitals. METAVIR F3 and F4 HCV monoinfected patients who were treated with PEG-IFN and RBV had their data analyzed. A stepwise logistic regression analysis was performed to identify the variables independently related to SVR. Adverse events were recorded during treatment.


RESULTS
308 patients were included, 75% genotype 1 and 23% genotype 3. METAVIR F3 was present in 39% and F4 in 61% of patients. The median Child Pugh score for F4 patients was 5 (5-9). The global SVR rate was 34%, 11% were relapsers and 55% were nonresponders. SVR rates were similar between patients treated with PEG-IFN alfa 2a or alfa 2b (p=0.24). SVR rates according to Child-Pugh score were 26% (Child A) and 18% (Child B). The independent factors related to SVR in F4 patients were genotype 3, RVR and fewer Child Pugh score points. Treatment interruption occurred in 31% patients and death occurred in 1.9%, all with liver cirrhosis.


CONCLUSIONS
Treatment of HCV in patients with advanced fibrosis should not be postponed. However, a very careful evaluation of cirrhotic patients must be performed before treatment is indicated and careful monitoring is required during treatment.
Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil. Electronic address: giovanni@fmb.unesp.br.
Giovanni Faria
GF
Silva
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Cristiane A
CA
Villela-Nogueira
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Carlos Eduardo Brandão
CE
Mello
Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
Elza Cotrim
EC
Soares
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Henrique Sergio M
HS
Coelho
Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Paulo Roberto Abrão
PR
Ferreira
Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
Fernando José Goes
FJ
Ruiz
D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000235:genetics; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D019562:Viral Load
D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
Advanced fibrosis; Hepatitis C; Peginterferon; Ribavirin