title: Hepatitis C virus therapy with peg-interferon and ribavirin in Myanmar: A resource-constrained country.
abstract: OBJECTIVE
  To investigate peg-interferon (peg-IFN) and ribavirin (RBV) therapy in Myanmar and to predict sustained virologic response (SVR).
  
  
  METHODS
  This single-center, open-label, study was conducted in Myanmar between 2009 and 2014. A total of 288 patients infected with HCV genotypes 1, 2, 3 and 6 were treated with peg-IFN alpha-2a (180 μg/wk) or alpha-2b (50 to 100 μg as a weight-based dose) and RBV as a weight-based dose (15 mg/kg/d). Treatment duration was 48 wk for genotypes 1 and 6, 24 wk for genotype 2, and 24 or 48 wk for genotype 3 based on rapid virologic response (RVR). Those co-infected with hepatitis B received 48 wk of therapy.
  
  
  RESULTS
  Overall, SVR was achieved for 82% of patients and the therapy was well tolerated. All patients achieved SVR at equivalent rates regardless of HCV genotype (P= 0.314). Low fibrosis scores (P< 0.001), high baseline albumin levels (P= 0.028) and low baseline viral loads (P= 0.029) all independently predicted SVR. On the other hand, IL-28B TT and CC genotypes were not found to significantly predict SVR (P= 0.634;P= 0.618). Among those who completed treatment, the occurrence of RVR showed a > 96% positive predictive value for achieving SVR. Treatment duration did not significantly impact the likelihood of achieving SVR for patients infected with genotype 3 HCV (P= 0.371). The most common adverse events were fatigue (71%) and poor appetite (60%). Among patients with genotype 3 HCV, more patients in the 48-wk treatment group required erythropoietin than in the 24-wk treatment group (61.1%vs49.2%).
  
  
  CONCLUSIONS
  SVR rates were high with peg-IFN and RBV therapy in Myanmar. Fibrosis scores, baseline albumin, HCV RNA levels and RVR independently predicted SVR.
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Naomi Khaing Than
authors.initials: NK
authors.lastname: Hlaing
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Debolina
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Robert
authors.initials: R
authors.lastname: Mitrani
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Soe Htet
authors.initials: SH
authors.lastname: Arker
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Kyaw San
authors.initials: KS
authors.lastname: Win
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Nyan Lin
authors.initials: NL
authors.lastname: Tun
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Zaw
authors.initials: Z
authors.lastname: Thant
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: Khin Maung
authors.initials: KM
authors.lastname: Win
authors.affiliation: Naomi Khaing Than Hlaing, Soe Htet Arker, Kyaw San Win, Nyan Lin Tun, Zaw Thant, Khin Maung Win, Department of Hepatology, Mandalay General Hospital, Mandalay 02121, Myanmar.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000235:genetics; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D000072230:Sustained Virologic Response; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D012709:Serum Albumin; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a; D000075462:Serum Albumin, Human
keywords: Hepatitis C virus; Pegylated-interferon; Rapid virologic response; Ribavirin; Sustained virologic response