Safety and efficacy of the combined pegylated interferon and ribavirin in the treatment of chronic hepatitis C and predictors of treatment response

Our previous work showed that 48 weeks of the combined pegylated interferon alfa-2a 180 ?g/week SC (Pegasys®) and ribavirin 11 mg/kg/d per os was associated with 61% SVR among patients infected with genotype 4, i.e. intermediate between that observed with genotype 1 and 2-3. None of the patients who had not achieved a two-log decline in viral load by 8 weeks of treatment had SVR (El Makhzangy et al., J Med Virol, 2009).

In that same trial, we documented that patients with alpha-fetoprotein (AFP) levels above the median value had twice lower SVR (41% vs 80%) compared to those with levels under the median value, and this independently of the severity of fibrosis (see Figure below) (Males et al., Antivir Ther, 2007). The negative association of AFP with SVR was found again in another study in Egypt (Gad et al. Liver Int, 2008), in patients infected with genotype 1 in France (Abdoul et al., PLoS One, 2008), and in patients co-infected with HIV in France (Carrat et al., AIDS, 2008).  This finding is of particular relevance in Egypt, where alpha-fetoprotein is measured routinely in patients enrolled for treatment at the national treatment centres for ruling out hepato-cellular carcinomas.


Figure AFP


Main conlusion of these studies : a 48-week course of pegylated interferon and ribavirin was associated with a 61% SVR rate among patients with genotype 4 chronic hepatitis in Egypt. Alpha-fetoprotein is a simple and robust marker of treatment response that can be used in routine management of patients.


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fp7_01fp7_02 This project is funded
by the European Union