Dear
Editors:
I'm
treating a 30 year old female with hep c type 1b. Her viral loads have been low; pre-therapy at
225K. Bx showed grade one inflammation
and fibrosis. With therapy with peg-intron, she cleared her virus by week 8 of
therapy and has remained less than 50 copies for past 2 months. Her LTS remain
slightly elevated but less than 100. She
tolerates therapy very well. The
question l have concerns duration of therapy.
We had discussed treating for 6 months in view of her low viral load but
I worry about relapse. Is there any data
on this subgroup that would support shorter treatment or would you recommend
continuation for the standard 48 weeks of therapy?
GS,
MD
Dear
GS:
I
am not aware of any data correlating the duration of therapy needed for an
optimal SVR based on the baseline serum HCV RNA level for patients with any
genotype. I would thus treat your patient, who has genotype 1, for the standard
48 weeks to achieve the greatest likelihood of an SVR. The pivotal trials with
standard interferon alfa-2b plus ribavirin showed a significantly better SVR
with 48 vs 24 weeks of therapy, and the paper by Hadziannis et al in press in
the Annuals of Internal Medicine
showed the same results with peginterferon alfa-2a plus ribavirin, i.e., a
regimen of 48 weeks was associated with a significantly better SVR compared
with 24 weeks. In addition, the latter study showed that a 1000-1200 mg vs 800
mg dose of ribavirin also achieves better results in patients with genotype 1.
Fortunately, she is tolerating therapy well and hopefully this tolerance will
continue for the full course of therapy.