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Predictors of response to antiviral therapy for chronic hepatitis C virus infection

Author
David L Wyles, MD
Section Editor
David L Thomas, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

The introduction of direct-acting antiviral (DAA)-based therapies for chronic hepatitis C virus (HCV) infection has revolutionized the approach to HCV treatment, resulting in highly efficacious and well-tolerated therapy for nearly all patients. Because of such high success rates (over 90 percent for most populations), patient and viral features that historically predicted worse outcomes with interferon-based regimens have a limited impact on responses to combination DAA regimens. Rather than identify patients with a much lower chance of attaining cure (who thus might have forgone interferon-based therapy), such features influence treatment strategies with DAA regimens, such as duration of treatment and the need for the addition of ribavirin.

This topic reviews the patient and viral features that impact response to and selection of interferon-free combination DAA regimens for chronic HCV infection. The diagnosis of chronic HCV infection and the evaluation of patients prior to HCV treatment are discussed in detail separately. (See "Diagnosis and evaluation of chronic hepatitis C virus infection" and "Patient evaluation and selection for antiviral therapy for chronic hepatitis C virus infection".)

Specific regimen selection is discussed separately by genotype. (See "Treatment regimens for chronic hepatitis C virus genotype 1 infection in adults" and "Treatment regimens for chronic hepatitis C virus genotypes 2 and 3 infection in adults" and "Treatment regimens for chronic hepatitis C virus genotypes 4, 5, and 6 infection in adults".)

HISTORICAL PERSPECTIVE

Traditional predictors of response to interferon-based HCV therapy included both patient and viral factors. Patient factors that were associated with worse response to interferon-based therapy included male gender, older age, high body mass index (BMI), advanced liver fibrosis, history of failed treatment, black race, non-CC IL28B genotype, and the presence of certain comorbid conditions, such as HIV coinfection, insulin resistance, or diabetes. Viral factors that were associated with worse response included non-genotype-2 infection, high viral load, and unfavorable viral kinetics during treatment (eg, slow decline or rebound in viral level).

With interferon-based therapies, these factors played a prominent role in management decisions, in three ways:

                      

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Literature review current through: May 2017. | This topic last updated: Nov 01, 2016.
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