Treatment for Hepatitis C Virus Infection in Adults: Comparative Effectiveness
Background: Hepatitis C Virus Treatment and Sustained Virologic Response
The goal of treating chronic hepatitis C virus (HCV) infection is to prevent complications such as cirrhosis, liver failure, hepatocellular cancer, and death. The sustained virologic response (SVR) rate, typically defined as a decline in HCV RNA to undetectable levels 24 weeks after completion of antiviral treatment, is a marker of treatment because it is strongly associated with the long-term absence of viremia.
A number of factors affect response to antiviral treatment. The two major pretreatment predictors of an SVR are the viral genotype and the pretreatment viral load. HCV genotype 1 infection is associated with a substantially lower response to antiviral treatment than infection with genotypes 2 and 3. A pretreatment viral load of <600,000 IU/mL is associated with lower likelihood of achieving an SVR. Other factors less consistently or less strongly associated with an increased likelihood of achieving an SVR include female sex, age less than 40 years, nonblack race, absence of insulin resistance, and absence of bridging fibrosis or cirrhosis on liver biopsy. Effects of race on the likelihood of achieving an SVR may be due in part to polymorphisms in the interleukin-28B (IL28B) gene.
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