Efficacy And Safety Of Interferon Plus Ribavirin For Treatment Of Chronic Hepatitis C

Objective:To evaluate the effect and safety of the anti-viral treatment withinterferon combination with ribavirin in hepatitis C and influence factors.Approach:1.According to a retrospective and prospective studies, based onclinical data on accordeding with inclusion criteria of the64patients who haveundergone treatment at the Infection Department of the first Affiliated Hospitalof Guangxi Medical University during two years from July2010to August2012,While collecting the patients’ demographic information and route ofinfection;2. All patients were treated with interferon (including short-acting andlong-acting interferon) plus ribavirin for48weeks, while the patients werefollowed up to24weeks after discontinuation（If the patient is discontinuation inrecurrence of24weeks follow-up time to recurrence）;It is detected in patientswith liver function, blood, and Serum HCV RNA,which is detected beforetreatment,4weeks,12weeks,24weeks,48weeks after treatment and afterstopping4weeks,12weeks,24weeks;3. Comparing two groups of patient whoget different RVR, EVR, SVR ratio and evaluated the efficacy after antiretroviral therapy;4.Through grouping the cases by the baseline virus loadinto the higher virus load group (HCV RNA≥8.0×105IU/ml) and the lower virusload group (HCVRNA<8.0×105IU/ml), analysis of different genotypes andbaseline HCV RNA viral load in patients with chronic hepatitis C is done toevaluate the impact of antiviral efficacy.Result:1.Enrolled64patients with chronic hepatitis C, Having the57casescompleted48weeks of treatment and24weeks of follow-up,quitting two casesbecause of side effects,shedding five cases, and finally57cases entered thestudy.2.48cases in57patients were detected genotype. Their overall prevalencewere52.1%for type1b,20.8%for type6a,12.5%for type3b,8.3%for type2a,and6.3%for type1a.3.57patients had completed the full course of treatmentand follow-up of24weeks after drug withdrawl treatment,The incidences ofrapid virological response(RVR), early virological response (EVR), Sustainedvirological response(SVR)were71.9%,96.5%,84.2%respectively. Accordingto the different types of interferon, short-acting interferon group had34patientsand pegylated interferon group had23cases, The incidences of RVR, EVR,SVR in two groups were85.3%,97.1%,82.4%and52.2%,95.7%,87.0%respectively.By comparing the two groups who was statistically significantdifference except RVR, EVR and SVR was no significant difference.4. Analysisof the effects of the treatment with the genotype:48cases had the virus genotypewith the patients in completing the full course of treatment and follow-up of24weeks after drug withdrawl treatment. The incidences of RVR, EVR, SVR ingenotype1and genotype2,3were57.1%,92.9%,75.0%and80.0%,100.0%,90.0%respectively, The incidences of RVR, EVR, SVR ingenotype6were90.0%,100.0%,100.0%.There was no significant difference (P> 0.0167) among the three groups.5. Analysis of the effects of the treatment withthe genotype and different types of interferon:In genotype1patients, withRVR,EVR,SVR rates of the group in which recombinant interferon a-2b is usedwith ribavirin and the group in which pegylated interferon a-2a is used withribavirin being76.9%,92.3%,76.9%and40.0%,93.3%,80.0%respectively,There was no significant difference (P>0.05) between the two groups. Ingenotype2,3patients, The RVR, EVR, SVR rates of subjects treated withrecombinant interferon a-2b group and pegylated interferon a-2a group were83.3%,100.0%,83.3%and75.0%,100.0%,100.0%respectively, while they were100%,100.0%,100.0%and50.0%,100.0%,100.0%respectively in genotype6patients and those rates were not significantly different between the two groups(P>0.05).6. Analysis of the effects of the treatment with the HCV RNA viralload and different types of interferon:When HCV RNA is in higher case (HCVRNA≥8.0×105IU/ml),the rate of RVR of recombinant interferon a-2b group isRVR85.7%, EVR85.7%and SVR85.7%,while the rate of RVR, EVR and SVRof pegylated interferon a-2a group being30.0%,90.0%and70.0%respectively.With the RVR rates and the EVR,SVR rates of the two groupsmake no statistical difference as P>0.05. When HCVRNA is in lower case(HCV RNA<8.0×105IU/ml), the RVR, EVR and SVR of recombinant interferona-2b group amounts to85.2%,96.3%,and81.5%respectively,while those ofpegylated interferon a-2a group severally registers69.2%,100.0%and100.0%,making no statistical difference (P>0.05).7. Analysis of the patientswithout SVR:9cases had recurrenced with the patients in completing the fullcourse of treatment and follow-up of24weeks after drug withdrawl treatment,6patients did not acquire RVR,5patients (83.3%) was genotype1and one case (16.7%) was genotype3;high and low viral load group were3cases (50.0%)respectively; short-acting and long-acting interferon group were four cases (66.7%) and2cases (33.3%), and3patients were RVRand EVR; the rate of relapse ofrecombinant interferon a-2b group and pegylated interferon a-2a group was6case (6/34,17.7%) and3case (3/23,13.0%)respectively; the rate of relapse ofgenotype1and non-genotype1was25.0%and5.0%respectively; the rate ofrelapse of high and low viral load group was4case(4/17,23.5%) and5case(5/40,12.5%) respectively, Without RVR recurrence rate was significantlyhigher than the RVR those, the difference was statistically significant,thatgenotype1and high viral load were higher recurrence rate, the difference wasnot statistically significant(P>0.05) between the rate of relapse ofthem.8.Adverse events between the two groups of patients during the treatmentof interferon are common adverse reactions, the incidence of adverse events issimilar with the two groups. Peginterferon α-2a group,8cases of neutropenialess than0.75×109/L and the reduction of135ug/week, but the recombinantinterferon α-2b group,4patients reduction (P value of0.078). Short-acting andlong-acting group had3case and6case due to mild anemia (Hb<100g/L)andreduction of the Ribavirin600mg/d(P value of0.167) respectively.Thyroiddysfunction in recombinant interferon α-2b group incidence (22.6%) wassignificantly higher than that of pegylated interferon α-2a group (4%), but thedifference was not statistically significant (P value of0.178).Conclusion:1.84.2%of CHC patients receiving interferon and ribavirinwith48weeks of antiviral therapy achieved SVR.2. With SVR rates of the genotype1patients and the non-genotype1patients being75.0%and95.0%respectively. 3.The rate of SVR of recombinant interferon α-2b and pegylatedinterferon-2a plus ribavirin had undifferentiated and security was good.4. The level of viral load does not affect SVR rates.5. For higher relapse rate of Chronic hepatitis C patients with genotype1and high viral load group who require prolonged treatment to improve SVRrates and lower relapse rate.