This real world experience with treating Hepatitis C confirms many of the randomized clinical trials that have been published in the Hepatology literature over the last number of years.
While the Standard Of Care (S.O.C.) has changed for genotype 1 infected patients, it remains the pegylated interferon and ribavirin for genotypes 2, 3, and 4. The data from this real world experience serve as a guide for the education of our patients that are considering or undergoing antiviral therapy.
In genotype 2 patients, those that demonstrate undetectable Hepatitis C RNA (HCV RNA) titers less than 50 in international units per mL by weeks 2, 4, and 12 ultimately went on to demonstrate Sustained Virological Response (SVR) rates of 82%, 76.3%, and 74.2%, respectively. Among genotype 3 infected individuals, these same rates of ultimate SVR after demonstrating undetectable Hepatitis C RNA at weeks 2, 4 and 12 were 67.3%, 63.3%, and 63.8%, respectively. These rates are 10-15 percentage points below what is propagated in the medical literature, but more accurately reflects real world experience. The treating Physician can quote these numbers to the Hepatitis C infected individuals undergoing antiviral therapy and use them to encourage them to complete their course of treatment if they are destined for achieving a sustained virological response (i.e., cure).
On the other hand, a lack of Hepatitis C RNA negativity at week 12 has the highest negative predictive value across all genotypes and should raise the discussion for the cessation of therapy, particularly in that individual who is tolerating therapy poorly or has had a number of adverse reactions. The current Standard Of Care (S.O.C.) for Hepatitis C genotype 1 infected individuals is a protease inhibitor, interferon and ribavirin.