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[orleans]

Treatment of chronic hepatitis C in Asia: when East meets West
Last updated: 14 April 2009

Data from Kaohsiung Medical University, Department of Internal Medicine provide new insights into hepatitis C virus therapy

New research, 'Treatment of chronic hepatitis C in Asia: when East meets West,' is the subject of a report. "The issue of best treatment for chronic hepatitis C virus (HCV) infection is in constant flux, not only in Western countries but also in Asia. Currently, pegylated-interferon plus ribavirin is the standard of care," investigators in Kaohsiung, Taiwan report.

"Studies from Asia provide evidence to support the same broad treatment strategies for Asian patients as recommended in Western countries. Nevertheless, there is increasing evidence that Asians have a higher likelihood of achieving a sustained virological response (SVR) than their Caucasians counterparts when treated with the corresponding regimen.

With the recommended 'standard dose and duration treatment regimens', SVR is achieved in Asia for around 70% of HCV genotype 1 (HCV-1) infected cases, approximately 90% of HCV-2/3, approximately 65% of HCV-4, and approximately 80% of HCV-6 patients. Difference of body weight in race might contribute to the superior response in Asian patients. HCV genotype distribution in Asia also differs from North-America/Europe. HCV-6 and its variants, previously mistyped as HCV-1, needs accurate genotyping. Increasing data support the proposal that HCV genotype, baseline viral load and on-treatment virological response provide information for decision-making so that treatment can be individualized.

Beyond the older recommendations, an abbreviated 24-week regimen could be suggested for HCV-1/4 patients with baseline viral loads <400 000 IU/mL and a rapid virological response (RVR, HCV RNA undetectable at week 4), and an abbreviated 12-16 weeks of pegylated-interferon with weight-based doses of ribavirin could be suggested for HCV-2/3 patients with a RVR. Such tailored treatment regimens can reduce the costs of treatment and incidence of adverse events without compromising efficacy.

Hepatitis C virus (HCV) infection is one of the most important causes of cirrhosis worldwide, and particularly in some countries of Asia (notably Japan) where it is now more prevalent than chronic hepatitis B virus infection. Hepatitis C virus infection can also lead to hepatocellular carcinoma (HCC). It is estimated that there are more than 170 million people chronically infected with HCV, and 3 to 4 million persons are newly infected each year. The risk for developing cirrhosis 20 years after initial HCV infection among those chronically infected varies between studies, but is estimated at around 10%-15% for men and 1-5% for women. Once cirrhosis is established, the rate of developing HCC is at 1%-4% per year.

Approximately 280 000 deaths per year are related to HCV infection. Hepatitis C virus-related end-stage liver disease and HCC have become the leading cause for liver transplantation worldwide. In the Asia-Pacific area, the estimated prevalence of antibodies to HCV (anti-HCV) range from 0.3% in New Zealand to 5.6% in Thailand. In Japan, Middle East, Vietnam and Taiwan, several HCV hyper-endemic areas have been reported with an anti-HCV prevalence rate of 12% to as high as 58%. In addition to the well-known endemic status of HBV infection in most countries of the Asia-Pacific region, HCV infection presents another critical scenario of public health issue in this region, as outlined in Guidelines by the Asia-Pacific Association for Study of the Liver (APASL)," wrote M.L.

The researchers concluded: "Given the lack of an effective vaccine, optimal treatment of chronic HCV infection is now perceived as a 'must' in terms of public health strategies, as well as of the clinical setting for individual patients."

Yu and colleagues published their study in the Journal of Gastroenterology and Hepatology (Treatment of chronic hepatitis C in Asia: when East meets West. Journal of Gastroenterology and Hepatology, 2009;24(3):336-45).

[springfever]

Interesting...thanks.

[meakea]

Thanks for the post Orleans.  I'm in week 32 of 48 and, at my next appt with my GI's NP, I am going to print this study and a few others that I've saved over the past 8 months, and discuss them with her.

I started TX with a VL of 30,100 (G1b) and I was UND at week 4.  The only problem is that I don't yet know what the sensitivity of the wk 4 VL was.  Just told me UND.  I seem to fit the category for consideration of 24 wks instead of 48.  I wasn't mentally prepared to consider stopping at 24 wks but I am very open to the possibility of maybe doing the formula of adding 36 weeks at the week of UND which would be 40 wks of TX for me.  

I think I'm interested in going full dose to 40 and then doing a gradual taper after that to finish out the 48 weeks.  

I'm just thinking and gathering information to talk to my doc/NP about.

Thanks again.