Predictive Value of Early Viriological Response for Sustained Viriological Response in Chronic Hepatitis with Conventional Interferon Therapy.

BACKGROUND Hepatitis is a major public health problem in Pakistan due to its strong association with liver failure and hepatocellular carcinoma. In Pakistan, conventional interferon therapy along with Ribavirin is favoured especially in Government funded programs for treatment of Hepatitis C, over the more expensive Pegylated Interferon and Ribavirin combination therapy as recommended by Pakistan society of Gastroenterology and GI endoscopy due to its favourable results observed in genotype 3 which is the dominant genotype of this region. Objective of our study was to assess the virological responses with standard interferon therapy and to determine the predictive values of early virological response (EVR) for Sustained Virological Response (SVR) in chronic hepatitis C patients treated with standard interferon therapy. METHODS A cross sectional study was conducted on patients with chronic hepatitis C having received standard interferon and ribavirin therapy for six months. EVR and SVR were noted for analysis. Positive and negative predictive values of EVR on SVR were calculated. RESULTS Out of the total sample (N = 3075), 1946 (63.3%) patients were tested for EVR. 1386 (71.2%) were positive while 560 (28.8%) were negative while 516 (16.8%) were tested for SVR. Two hundred and eighty-five (55.2%) were positive while 231 (44.8%) were negative. EVR and SVR tested were n=117. Positive predictive value of EVR on SVR was 67.1% and negative predictive value was 65.8%. Statistically significant association between EVR and SVR was determined with Chi square statistic of 11.8 (p-value < 0.0001). CONCLUSION EVR is a good predictor of response of patients to standard interferon and ribavirin therapy. In the absence of an EVR, it seems imperative to stop further treatment. Virlogical responses with conventional interferon therapy are comparable to those of pegylated interferon therapy so adoption of conventional INF therapy is justified in terms of its cost effectiveness especially in resource constrained nations like Pakistan.