A patient who is being treated for hepatitis C genotype 1a did not achieve an early viral response to interferon and ribavirin therapy at four weeks. However, a steady slow drop with resulting nondetectable viral load did occur at week 20 of a 48-week regimen. Is it reasonable to extend therapy to 72 weeks to increase the chances of sustained viral response (SVR)? — JAYE ELLEN RACANELLI, NP, Northport, N.Y.
It is reasonable to extend therapy to 72 weeks to increase the chances of SVR. This patient belongs to a category known as “slow virological responders,” which includes “those who achieve undetectable (hepatitis C virus) RNA in serum for the first time between weeks 12 and 24 of therapy. In this group, treatment with a standard 48-week course of treatment has been associated with a high rate of virological relapse when treatment was stopped” (Fried MW. HCV Genotype 1: how are you managing the non-responders and relapsers? In: Foster GR, Reddy KR, eds. Clinical Dilemmas in Viral Liver Disease. Hoboken, N.J.: John Wiley & Sons, Inc.; 2010:40).
One study conducted in the United States showed SVR rates for slow virological responders treated for 72 weeks at 38%, and only 18% for those treated for 48 weeks (Hepatology. 2007;46:1688-1694). However, this study was notable for its inclusion of numerous patients with difficult-to-treat characteristics (i.e., black race, high viral levels) .— Sharon Dudley-Brown, PhD, FNP-BC, co-director, gastroenterology & hepatology, Nurse Practitioner Fellowship Program, Johns Hopkins University Schools of Medicine & Nursing, Baltimore (152-06)