Treatment and retreatment in patients with chronic hepatitis C: 10 years clinical practice in a single centre

Therapy for chronic hepatitis C (HCV) has mainly been evaluated in large clinical, select population, trials. We sought to evaluate whether prognostic factors of therapeutic response are similar in clinical practice, where treated population is more diverse. Retrospective study of HCV-infected patients who completed > 6 months of treatment/retreatment with various therapeutic regimens, in a single reference centre over a 10-year period. Adjuvant treatment with hemopoetic growth factors was used when warranted by treatment side effects. Overall, 77/125 patients (61.6%) achieved sustained virological response (SVR). Fifty-four naive patients (43.2%) achieved SVR; 19 (26%) with interferon-alpha (IFN-alpha), 13 (59.1%) with IFN-alpha and ribavirin, and 22 (73.3%) with pegylated IFN-alpha and ribavirin. Seventeen patients responded after two courses of therapy and six after more than three courses, achieving a total SVR of 32%. Patients with genotype-1 were less probable to achieve SVR [odds ratio (OR)=6.23], while younger patients were more possible to achieve SVR, OR=0.97. Most non-responders after > 2 regimens were genotype-1 patients (90%). In clinical practice, where strict selection criteria cannot be applied, genotype-1 remains the most significant prognostic factor of response failure. Addition of adjuvant hemopoetic growth factors, when warranted, may increase compliance and thus overall SVR.