Hepatitis Journal Club

Superior response to pegylated interferon and ribavirin in Asians with chronic hepatitis C.

I. Citation: Pattullo V, Heathcote EJ, and Wong DK. Superior response to pegylated interferon and ribavirin in Asians with chronic hepatitis C. Hepatol Int. 2010; 4(4): 723-31.

II. Background: The standard treatment for chronic hepatitis C (CHC) is pegylated interferon combined with ribavirin. Several factors may decrease the efficacy of the treatment such as genotype 1 hepatitis C virus (HCV), higher viral load, obesity, insulin resistance, advanced fibrosis, hepatic steatosis, the expression of interferon-λ gene, or ethnicity of host which is measured by the sustained virological response (SVR). Many have reported that African-Americans, Hispanics, and South Asians have lower SVRs than Caucasians. However, studies with East Asians showed higher levels of SVR: 79% for gentoype 1 and 95% for genotype 2 CHC. Although the specific cause of this is unknown, it may be due to this ethnic population’s low body weight/BMI indicating that these patients get a higher ribavirin dose per kilogram of body weight in non-weight-based dosing. Another etiology may be race-based genetic polymorphisms, specifically in the human leukocyte antigen, TNFα-308 promoter gene, or interferon-λ 28B. No studies exist to compare the correlation between race and virological response to standard CHC treatment, thus proving the need for such a study to be conducted.

III. Objective: To determine if Asian race independently predicts the sustained virological response (SVR) in patients with chronic hepatitis C receiving pegylated interferon and ribavirin as treatment.

IV. Study Design: retrospective study.

V. Methodology

a. Inclusion Criteria: all patients infected with genotypes 1, 2, or 3 chronic hepatitis C (CHC) treated with pegylated interferon-a and ribavirin from June 2001 to March 2009 at the Toronto Western Hospital

b. Exclusion Criteria: patients of ethnicity other than...