Alanine Transaminase ; blood ; Genotype ; Hepacivirus ; classification ; genetics ; Hepatitis C, Chronic ; drug therapy ; immunology ; virology ; Humans ; RNA, Viral ; blood

OBJECTIVESTo study the effects of HCV genotypes and HLA-DRB alleles on the response of chronic hepatitis C patients to interferon alpha and libavilin.

METHODSGenotypes of HCV in 113 patients with HCV infection treated with interferon alpha and libavilin were investigated. Gene chips were used to analyze the frequency of HLA-DRB alleles in 25 patients of them. The response to interferon alpha and libavilin therapy were discussed.

RESULTSThe response rates in the four HCV types were different, HCV-IV/2b the highest (57.78%), HCV-I/1a and -III/2a lower (46.15% and 47.62%), and HCV-II/1b the lowest (11.76%). The response rate to IFN and libavilin therapy in patients with DRB1*07 positive was higher, while in patients with DRB1*04 positive was lower. Sex, HCV genotypes and HLA-DRB alleles were all related to the response. Female, patients with HCV-IV/2b and HLA-DRB1*07 presented almost complete response, but male, patients with HCV-II/1b and HLA-DRB1*04 usually appeared non-response. DRB1*07 allele and HCV-IV/2b were the closest factors related to the response.

CONCLUSIONSNot only virus but also host playes an important role in the curative effect of anti-virus therapy. It is necessary to view from the angle of host, adjusting the host's immune status to accelerate the clearance of HCV.

Adult ; Alleles ; Antiviral Agents ; therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; HLA-DR Antigens ; genetics ; HLA-DRB1 Chains ; Hepacivirus ; classification ; genetics ; Hepatitis C, Chronic ; drug therapy ; immunology ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Male ; Middle Aged ; Ribavirin ; therapeutic use

Combination therapy with interferon alpha (IFN- alpha) and ribavirin for 24 or 48 weeks according to HCV genotype has improved the overall sustained virological response (SVR) rates to approximately 40%. The aim of this study was to investigate the long-term efficacy of combination therapy with IFN-alpha and ribavirin for chronic hepatitis C in Koreans. One hundred thirty-eight patients with chronic hepatitis C who received this combination therapy between 1995 and 2003 were analyzed retrospectively. All patients were treated with IFN-alpha 3-6 million units three times weekly in combination with 900-1200 mg/day of ribavirin for 24 weeks. The overall SVR rate was 41.3%. Patients were followed up for a median of 41 months (range, 12-105 months) after completion of therapy. In all of the SVR patients (57 patients), SVR was conserved during the follow-up period. None of the patients progressed to decompensated liver disease or hepatocellular carcinoma (HCC). However, 5 of the 81 non-SVR patients (6.2%) progressed to decompensated liver disease or HCC. In conclusion, combination therapy with IFN-alpha and ribavirin shows good long-term efficacy in patients with chronic hepatitis C in Korea, one of the highest endemic areas of hepatitis B virus (HBV) infection.
Ribavirin/adverse effects/*therapeutic use ; Retrospective Studies ; Middle Aged ; Male ; Korea ; Interferon-alpha/adverse effects/*therapeutic use ; Humans ; Hepatitis C, Chronic/*drug therapy/immunology/virology ; Follow-Up Studies ; Female ; Drug Therapy, Combination ; Antiviral Agents/adverse effects/*therapeutic use ; Adult

Peg-interferon and ribavirin has been the standard therapy of chronic hepatitis C for the past 15 years in Korea. However, the treatment paradigm is changing. Direct acting agents (DAAs) are oral pills that can be easily taken. In addition, DAAs are more effective and have less adverse reactions compared to the previously used drugs. Chronic hepatitis C is hard to treat because the virus is error-prone virus. Host immunity is helpless against the hepatitis C virus since it evades the host immunity through various complex mechanisms. There are 6 genotypes. Quasispecies can co-exist even in the same patients. The treatment strategy is based on the combination of the individual drug corresponding to each step of viral replication process. NS5B nucleosides are the most powerful and effective drug available until now. Other drugs with different mechanisms of action can be used to provide synergy. NS5A and NS5B inhibition drugs currently belong to the leading group amongst many DAAs. These drugs will soon be available in Korea. We have to know the merits and adverse drug reactions of the new drug.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Enzyme Inhibitors/therapeutic use ; Genotype ; Guidelines as Topic ; Hepacivirus/genetics ; Hepatitis C, Chronic/*drug therapy/immunology/virology ; Humans ; Viral Nonstructural Proteins/antagonists & inhibitors/metabolism

BACKGROUNDIt is internationally accepted that in drug-naïve individuals with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, chronic hepatitis C should be treated first if the CD4 cell count does not require the initiation of anti-retroviral therapy. Present paper evaluated the clinical effect and side-effect of interferon-alpha (IFN-alpha) and ribavirin (RBV) combination therapy for Chinese patients with HCV-HIV co-infection, and compared with them for HIV infection alone.

METHODSTen patients with HCV-HIV and 17 patients with HCV received 5 million unit IFNalpha-2b every other day intramuscularly, and 300 mg RBV triple daily by oral. Dynamic observations were made for HCV RNA and HIV RNA loads, CD4+ and CD8+ T lymphocyte counts, liver function and blood cell measurement, and the medicine side-effects.

RESULTSAfter 12-week and 24-week treatments of IFN-alpha and RBV combination therapy, mean HCV RNA levels reduced 1.14 logs and 1.56 logs from the baseline at week 0 in HCV-HIV co-infection, and reduced 1.48 logs and 1.75 logs in HCV infection, respectively. The HIV RNA levels decreased 1.22 logs and 1.32 logs from the base line; however, there were no obvious different changes at T lymphocyte counts of HCV-HIV and HCV patients through 24-week treatments. Whole 27 patients showed satisfactory biochemical response to therapy. There were some mild or mediate influence-like symptoms, intestinal uncomfortable and depressed blood cell counts in early stage of the treatments. No neuropsychiatric and auto-immune disorders were found.

CONCLUSIONSIFN-alpha and RBV combination therapy had similar anti-HCV effects during 24-week treatment for HCV-HIV and HCV infected Chinese patients, and some anti-HIV effect. There were no obvious different biochemical responses and side-effects between two groups above.

Adult ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Drug Therapy, Combination ; Female ; HIV Infections ; drug therapy ; immunology ; virology ; Hepatitis C, Chronic ; drug therapy ; immunology ; virology ; Humans ; Interferon-alpha ; administration & dosage ; Male ; Middle Aged ; RNA, Viral ; analysis ; Recombinant Proteins ; Ribavirin ; administration & dosage

OBJECTIVETo perform a Meta-analysis on peginterferon with interferon in treatment of HIV patients coinfected with refractory genotype HCV.

METHODSA literature search of Medline was conducted to identify eligible randomized controlled trials. Meta analysis was conducted to evaluate peginterferon and interferon in treatment of coinfected HCV genotype 1 or 4 in HIV patients.

RESULTSix trials of 88 matched the selection criteria. Total 1,131 patients with coinfection of HCV genotype 1 or 4 and HIV were included. Sustain viral response was higher in patients treated with peginterferon plus ribavirin compared with that of interferon plus ribavirin (26 % compared with 8 %) or peginterferon alone (26 % compared with 13 %). Severe adverse effects and withdrawal rates were similar for patients treated with peginterferon and patients treated with interferon.

CONCLUSIONPeginterferon plus ribavirin in treatment of patients with coinfection of genotype 1 or 4 HCV and HIV can achieve higher sustain viral response and the likelihoods of serious adverse effects and withdrawal rates are similar to other therapies.

Adult ; Antiviral Agents ; administration & dosage ; Drug Therapy, Combination ; Female ; Genotype ; HIV Infections ; complications ; drug therapy ; immunology ; Hepacivirus ; classification ; genetics ; Hepatitis C, Chronic ; complications ; drug therapy ; virology ; Humans ; Interferon-alpha ; administration & dosage ; Male ; Polyethylene Glycols ; administration & dosage ; Randomized Controlled Trials as Topic ; Recombinant Proteins ; Ribavirin ; administration & dosage

Pegylated interferon alfa-2a (PEG-IFN) and ribavirin combination therapy is the first line treatment for chronic HCV infection. There are four reports of Bell's palsy associated with interferon-alpha (IFN-alpha) and ribavirin therapy. We report here a case of Bell's palsy that occurred in a patient with chronic HCV infection during combination PEG-IFN and ribavirin therapy. The patient was 49-year-old man with chronic hepatitis C for 2 years. The liver biopsy showed grade 1 and stage 1. Therapy with PEG-IFN (Pegasys) 180 microgram/week and ribavirin 1200 mg/day was initiated. After 3 weeks of treatment, the patient showed a loss of muscular tone on the left side of his face. A diagnosis of Bell's palsy was made, and the PEG-IFN and ribavirin therapy was stopped. Prednisolone 45 mg/d was given and then tapered for 8 weeks. His palsy improved over 6 weeks.
Adult ; Antiviral Agents/*adverse effects ; Bell Palsy/*etiology/immunology ; Hepatitis C, Chronic/complications/*drug therapy/virology ; Humans ; Interferon Alfa-2a/*adverse effects/therapeutic use ; Male ; Middle Aged ; Polyethylene Glycols/*adverse effects/therapeutic use ; Ribavirin/administration & dosage/*adverse effects/therapeutic use ; Treatment Outcome