May some HCV genotype 1 patients still benefit from dual therapy? The role of very early HCV kinetics

作者：Tontodonati Monica^*; Cento Valeria; Polilli Ennio; Colabattista Cecilia; Cascella Raffaella; Sciotti Maria Pina; Di Giammartino Dante; Trave Francesca; Di Maio Velia Chiara; Monarca Roberto; Di Candilo Francesco; Prinapori Roberta; Rastrelli Elena; Vecchiet Jacopo; Ceccherini Silberstein Francesca; Manzoli Lamberto; Giardina Emiliano; Perno Carlo Federico; Parruti Giustino

来源：New Microbiologica, 2015, 38(4): 491-497.

• HCV dual therapy
• Early viral kinetics
• HCV therapy optimization
• EVR
• RVR

When treating HCV patients with conventional dual therapy in the current context of rapidly evolving HCV therapy, outcome prediction is crucial and HCV kinetics, as early as 48 hours after the start of treatment, may play a major role. We aimed at clarifying the role of HCV very early kinetics.
We consecutively enrolled mono-infected HCV patients at 7 treatment sites in Central Italy and evaluated the predictive value of logarithmic decay of HCV RNA 48 hours after the start of dual therapy (Delta48).
Among the 171 enrolled patients, 144 were evaluable for early and sustained virological response (EVR, SVR) prediction; 108 (75.0%) reached EVR and 84 (58.3%) reached SVR. Mean Delta48 was 1.68 +/- 1,22 log(10) IU/ml, being higher in patients with SVR and EVR.
Those genotype-1 patients experiencing a Delta48 >2 logs showed a very high chance of success (100% positive predictive value), even in the absence of rapid virological response (RVR). Evaluation of very early HCV kinetics helped identify a small but significant proportion of genotype-1 patients (close to 10%) in addition to those identified with RVR, who could be treated with dual therapy in spite of not reaching RVR.
In the current European context, whereby sustainahility of HCV therapy is a crucial issue, conventional dual therapy may still play a reasonable role in patients with good tolerance and early prediction of success.

• 出版日期2015-10