Response to combination therapy in hepatitis virus C genotype 2 and 3.

OBJECTIVE To determine Sustained Viral Response (SVR) to Interferon (IFN) and ribavirin therapy in chronic hepatitis C patients of genotype 2 and 3. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY The Garden Clinic, Lahore, from June 1997 to August 2007. METHODOLOGY All patients of both genotypes 2 and 3 receiving combination therapy were included. Standard IFN with ribavirin was started in 648 (90%) patients of genotype 2 and 3, whereas 73 (10%), all genotype 3 received pegylated IFN. Outcome parameters including End of Treatment Response (ETR) [negative PCR at the end of therapy], sustained viral response (SVR) [negative PCR both at the end of treatment and 6 months later] and relapse (PCR negative at the end of treatment but positive 6 months later) were determined. Data were analyzed using student's t-test and Chi-square. RESULTS A total of 721 patients of genotype 2 and 3 were evaluated with male to female ratio of 1.78:1 and mean age 39.8 +/- 9.17 years. Twenty six (3.6%) patients were of genotype 2, while 695 (96.4%) had genotype 3. Six hundred and ten patients (84.6%) completed therapy, as per protocol, whereas 58 (8.04%) had therapy beyond 6 months. SVR was 72.7% with better outcome in genotype 2 (80%) than in 3 (72%) and in those on pegylated IFN and ribavirin (85%) than patients on standard IFN-based therapy (71.1%). Relapse was seen in 116 (16.1%) and 80 (11.1%) were non-responders. Patients with baseline ALT 2-4 x UNL had better SVR than patients with ALT < 2x UNL (p-value 0.01). CONCLUSION Genotype 3 was the predominant type of virus in the studied patients. SVR patients was 72.7%. Outcome was better with high baseline ALT and pegylated interferon combination therapy.