Classification of virologic responses based on outcomes during and after a 48-week course of pegylated interferon (PEG IFN) plus ribavirin antiviral therapy.

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Classification of virologic responses based on outcomes during and after a 48-week course of pegylated interferon (PEG IFN) plus ribavirin antiviral therapy in patients with hepatitis C, genotype 1 or 4 (for genotype 2 or 3, the course would be 24 weeks). Nonresponders can be classified as null responders (hepatitis C virus [HCV] RNA reduction of <2 log10 IU/mL) or partial responders (HCV RNA reduction ≥2 log10 IU/mL but not suppressed to undetectable) by week 24 of therapy. In responders, HCV RNA can become undetectable, as shown with sensitive amplification assays, within 4 weeks (RVR, rapid virologic response); can be reduced by ≥2 log10 IU/mL within 12 weeks (early virologic response, EVR; if HCV RNA is undetectable at 12 weeks, the designation is “complete” EVR); or at the end of therapy, 48 weeks (ETR, end-treatment response). In responders, if HCV RNA remains undetectable for 24 weeks after ETR, week 72, the patient has a sustained virologic response (SVR), but if HCV RNA becomes detectable again, the patient is considered to have relapsed. In patients treated with protease inhibitor–based therapy, several additional milestones are monitored: (1) among boceprevir-treated patients, the level of HCV RNA reduction (>1 log10 or ≥1 log10 IU/mL) during the 4-week PEG IFN–ribavirin lead-in phase; (2) during boceprevir therapy, undetectable HCV RNA at week 8 (week 4 of triple-drug therapy; RVR); and (3) among telaprevir-treated patients, undetectable HCV RNA at week 4 and 12 (extended RVR). (Reproduced with permission, courtesy of Marc G. Ghany, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health and the American Association for the Study of Liver Diseases. Hepatology 49:1335, 2009.) Source: Chronic Hepatitis, Harrison's Principles of Internal Medicine, 19e Citation: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine, 19e; 2015 Available at: http://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/1130/kas_ch362_f002.png&sec=98728277&BookID=1130&ChapterSecID=79748717&imagename= Accessed: October 09, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved