With regard to antiviral therapy for chronic hepatitis C, the ICSI Technology Assessment Committee finds that:
Peg-IFN and the combination of peg-IFN and ribavirin are generally safe when closely monitored in an experienced center. Serious side effects occur in 7-14% of cases.
Studies are in progress to determine the effect of chronic suppressive antiviral therapy in preventing complications of liver disease. No results have yet been published.
Peg-IFN results in a sustained response (SR: undetectable hepatitis C virus RNA 6 months after treatment) in approximately 25-39% of the patients treated (as compared to 20% for IFN treatment).
Peg-IFN and ribavirin (combined) have shown a SR rate of approximately 54% (as compared to 42% to 47% for IFN and ribavirin treatment). The most important predictor of success in achieving a sustained response is HCV genotype. Additional predictors include presence of cirrhosis and HCV RNA level.
Patients who achieve a SR are likely to maintain that response permanently. Patients who maintain their response permanently are likely to have regression of histologic changes in the liver. (Conclusion grade II)
The natural history of hepatitis C is not fully understood. Factors that are independently associated with the development of fibrosis include age at infection, infection duration, alcohol intake, and male sex.
For patients with compensated cirrhosis or fibrosis, sustained response rates have ranged from 17% (IFN plus ribavirin) to 30% (peg-IFN). (Conclusion grade II)
