Treatment of Hepatitis C Virus Infection in Patients with End-stage Renal Disease

Chen-Hua Liu; Jia-Horng Kao

Disclosures

J Gastroenterol Hepatol. 2011;26(2):228-239. 

In This Article

Definition of HCV Virological Response Following IFN-based Therapy

The goal of HCV treatment is to decrease liver-related morbidity and mortality. Because the evolution to end-stage liver disease in ESRD patients with chronic HCV infection usually takes several decades, it is difficult to show the beneficial effect of treatment on the prevention of liver-related complications. Sustained viral suppression, rather than long-term clinical outcome, is therefore defined as the surrogate end-point of IFN-based therapy. Table 2 shows the definition of virological responses to treatment in chronic hepatitis C. The most important is sustained virological response (SVR), defined as undetectable HCV-RNA, 24 weeks after the completion of therapy by a sensitive HCV-RNA assay. This end-point is generally believed to be a 'virological cure', although some patients might still develop liver-related complications (particularly hepatocellular carcinoma) years after achieving SVR, especially those with advanced fibrosis and other risk factors for liver disease (alcohol, diabetes, occult hepatitis B virus infection). A rapid virological response (RVR), defined as undetectable HCV-RNA at week 4 of treatment, and early virological response (EVR), defined as an undetectable polymerase chain reaction (PCR; complete EVR [cEVR]) or ≥2 log reduction of HCV-RNA at week 12 of treatment to the baseline viral level (but still PCR positive; partial EVR). RVR and cEVR are strong positive predictors of SVR in chronic hepatitis C patients with normal renal function.[93]

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