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Hepatitis C and Liver Transplantation

State of the art treatment of hepatitis C

Publication ,  Chapter
Tillmann, HL; Thompson, A; Patel, K
January 1, 2010

Over the last decade, chronic hepatitis C (HCV) infection has seen a dramatic change in the success of treatment with the evolution of standard-of-care. While 24 week standard interferon-alpha monotherapy led to sustained viral response rates in the range of 5 to 10%, current standard-of-care with pegylated interferon and ribavirin has improved overall sustained viral response to 50%. However, there are significant differences between genotypes. Genotype 1a and 1b, which are the dominant viral genotypes in the developed world, are associated with sustained viral response rates of almost 50% in Europe and about 40% in the United States, while genotypes 2 and 3 are associated with response rates of around 80%. Two main areas of importance have emerged recently: 1) treatment decisions based on viral kinetics, and 2) management of side effects. The kinetics of viral decline during therapy allows in some patients the prediction of the likelihood of response even with shorter treatment duration. Thus, genotype 1 patients with a low baseline viral load and HCV ribonucleic acid less than 30 international units/ml at week 4 show >90% response rate with 24 weeks duration of therapy, while those still positive at week 12, show significantly impaired response rates. Major side effects of current therapy are depression and hematologic side effect of hemolytic anemia due to ribavirin, and thrombocytopenia and neutropenia due to interferon. Although both hemopoieitic growth factors and antidepressants are used frequently to treat side-effects, with some quality of life benefits, it seems unlikely that these adjunctive therapies actually result in improved sustained virologic response rates.

Duke Scholars

ISBN

9781617286162

Publication Date

January 1, 2010

Start / End Page

13 / 27
 

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Tillmann, H. L., Thompson, A., & Patel, K. (2010). State of the art treatment of hepatitis C. In Hepatitis C and Liver Transplantation (pp. 13–27).
Tillmann, H. L., A. Thompson, and K. Patel. “State of the art treatment of hepatitis C.” In Hepatitis C and Liver Transplantation, 13–27, 2010.
Tillmann HL, Thompson A, Patel K. State of the art treatment of hepatitis C. In: Hepatitis C and Liver Transplantation. 2010. p. 13–27.
Tillmann, H. L., et al. “State of the art treatment of hepatitis C.” Hepatitis C and Liver Transplantation, 2010, pp. 13–27.
Tillmann HL, Thompson A, Patel K. State of the art treatment of hepatitis C. Hepatitis C and Liver Transplantation. 2010. p. 13–27.
Journal cover image

ISBN

9781617286162

Publication Date

January 1, 2010

Start / End Page

13 / 27