الفهرس 
Hepatitis C virus infectionOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus infection is a serious worldwide problem. It has been estimated that there are over 170 million HCV infection worldwide, with an increasing incidence of new infections (3-4 million every year) .
There are considerable regional differences. In some countries, e.g., Egypt, the prevalence is as high as 22%.
Egypt has the highest prevalence of Hepatitis C Virus (HCV) worldwide, with more than 90% of infections due to genotype 4.
The current optimal therapy for patients with chronic hepatitis C virus (HCV) infection is the combination of peginterferon and Ribavirin.
There are many predictors for treatment response to interferon therapy and among these predictors RVR (rapid virological response) is the most important single predictor.
Predicting response in HCV treatment is very important in response guided therapy to consume both time and cost.
The aim of this study is to determine whether 4 week (rapid null response) can predict or correlate with 12-week (early null response) in patients with chronic hepatitis C virus infection treated with pegylated interferon plus weight-based ribavirin.
This study was carried out prospectively on 50 Adult patients with chronic Hepatitis C Virus (HCV) infection attending Shebein El-Kom Teaching Hospital, (Interferon Unit), treated with Pegylated interferon plus weighted based Ribavirin from January to April 2012.
Patients were classified into two groups based on a 4-week viral log decline compared with baseline:
Group Ι (rapid null responder) whom viral load decline less than < 1 log viral decline at 4 weeks were considered eNRs.
Group Π (rapid responder) whom viral load decline >1 log those patients with rapid viral response (RVR: HCV RNA undetectable at week 4) were also identified.
Patients were followed up to 12 weeks injections to establish early virological response and patients according to (EVR) classified to the following groups
Group1: early null responder whom viral load decline <2logs from basic viral load
Group2: early partial responder whom viral load decline >2logs from basic viral load but not undetectable
Group 3: early complete responder whom undetectable HCV RNA at week 12.
In our study rapid virological response achevied in 40 patients of (N= 50 )(80%) vs (20%) of patients(N= 10) who did not achieve rapid virological response(rapid null responders) , early virological response as regard rapid respoders (N=40) 37 patients of them achieved cEVR(complete virological response) (92.5%) while( N=3) of them achieved pEVR (partial early virological response)(7.5%)while (N=9 )of 10 patients rapid non responders failed to achieve early virological response (90%) &only one patient (10%) achieved early virological response .
According to our results as regards rapid virological response and early virological response we found that from 40 patients who were achieved RVR 37 patients(92.5% ) achieved complete early virological response and 3 patients achieved partial early virological response (7.5%) and among group of rapid non responders (n=10) 9 patients failed to attain early virological response(90%) and only one patient (10%)attained early virological response so totally 38 patients ( 76 %) attained cEVR.
According to results of our study as regard age and sex all rapid non responders, were males 10(100%), with a higher age( 49.70+7.05) comparing to rapid responders
As regrd relation of RVR &BM, body mass index was higher in rapid non responder group with statistical significance.
And in relation to viral load and RVR, viral load tends to be higher in RNR group however of no significance.
Roc curve analysis of RVR as a test of early virological response, the AUC is 75% with (92.31%) sensitivity ,( 91.28%)specificity, PPV(88.63%) and NPV (89.63%).
By univariate analysis predictors of early virological response with statistically significant values BMI (0.041), Viral load (0.009), Rapid virological response (0.047), Thrombocytopenia(0.025), Neutropenia (0.030) and reduction of ribavirin dose was ( 0.042).
By multivariate analysis RVR, viral load, BMI, neutropenia and thrombocytopenia were significant independent predictors of early virological response.
In conclusion RNR (rapid null response) was strongly associated with both failure to attain EVR (early virological response) and achieving only pEVR.