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Factors that Raise the Risk of Hepatitis C Relapse

Nicole Cutler L.Ac. July 12, 2011

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New research reveals more factors than previously recognized that can raise the risk of relapsing after Hepatitis C treatment.

One of the reasons we desperately need better treatments for Hepatitis C is because many who initially respond to treatment relapse. By recognizing which individuals are more likely to have a Hepatitis C relapse, healthcare practitioners may be able to make useful adjustments to their treatment protocol. For those most susceptible to a relapse, such an adjustment might improve their odds of remaining free of Hepatitis C.

About Hepatitis C Relapse

Often used to describe a recurrence of an autoimmune disease or return to a substance abuse disorder, the term relapse can be confusing. Technically, relapse is the act of falling or sliding back into a former state, regressing after partial recovery from illness or backsliding.

During the course of Hepatitis C therapy, there are various times when a person’s response to his or her medications is measured. By looking for RNA (genetic material) from the virus, this measurement determines if the drugs are defeating Hepatitis C. Unfortunately, a good percentage of people show an initial response to the Hepatitis C drug treatment only for the viral particles to resurface later.

A Hepatitis C relapse does not necessarily mean that a person achieved sustained virologic response – the inability to detect Hepatitis C RNA six months after treatment completion. In reality, the number of people who relapse after attaining sustained virologic response is very low. More commonly, a Hepatitis C relapse is regarded when individuals achieve an end-of-therapy response (an undetectable level of Hepatitis C RNA at the conclusion of therapy) and then the virus returns.

The Research Identifying Who Is Relapse Prone

Due to its potentially severe side effects, persevering through Hepatitis C therapy is quite a feat. This is especially true for those with genotypes 1 and 4, since they must complete a full 48 weeks of treatment. For those who are lucky enough to achieve an end-of-therapy response, there is still another hurdle to go. An estimated 30 percent of people who achieve an end-of-therapy response will relapse. For these people who have their Hepatitis C virus return, the factors rendering them more susceptible was relatively unknown until French researchers presented their study.

At the 2010 American Association for the Study of Liver Diseases “Liver Meeting” in Boston, interesting research by Christiane Stern and colleagues from Beaujon Hospital in Clichy, France was presented. The research team determined what variables made someone more likely to relapse after receiving the standard Hepatitis C treatment consisting of pegylated interferon and ribavirin.

The researchers followed 249 previously untreated chronic Hepatitis C patients who were given pegylated interferon alfa-2a (Pegasys) or pegylated interferon alfa-2b (PegIntron) plus weight-adjusted ribavirin. As is the norm, patients with genotypes 2 or 3 were treated for 24 weeks, while those with genotypes 1 or 4 were treated for 48 weeks. Several factors were found to play a role in higher rates of relapse in participants who achieved an end-of-therapy response. The factors that seemed to increase the risk of relapse include:

  1. Being infected with Hepatitis C genotype 1
  2. Having a significant amount of liver steatosis
  3. Receiving a reduced dose of pegylated interferon
  4. Being obese
  5. Being menopausal

Several of these factors come as no surprise to the Hepatitis C community; genotype 1 is notoriously stubborn, greater steatosis is known to hinder treatment and interferon dose reductions have repeatedly led to lowered treatment success rates. However, knowing that obesity and menopause also contribute to Hepatitis C relapse gives practitioners new information.

Whether lengthening treatment time, increasing drug dosages or adding another medication to Hepatitis C therapy, modifying antiviral treatment for obese or menopausal patients could help these more vulnerable individuals avoid a relapse.

References:

http://hepatitisdoctor.com/, Hepatitis Doctor Home, Retrieved December 26, 2010, Bennet Cecil, MD, 2010.

http://www.hcvadvocate.org/hcsp/articles/Keeffe-3.html, Management of Hepatitis C Treatment Failure, Emmet B. Keefe, MD, Retrieved December 26, 2010, Hepatitis C Support Project, 2010.

http://www.hivandhepatitis.com/2010_conference/aasld/docs/1210_2010_b.html, Menopause and Obesity Linked to HCV Relapse after Interferon-based Treatment, Liz Highleyman, Retrieved December 25, 2010, hivandhepatitis.com, 2010.

http://www.natap.org/2010/AASLD/AASLD_91.htm, Steatosis, Obesity, Peg-IFN Dose Reduction & Menopause are Associated with Relapse in Chronic Hepatitis C Patients Treated with Pegylated Interferon Plus Ribavirin, Jules Levin, Retrieved December 25, 2010, AASLD 61th Annual Meeting of the American Association for the Study of Liver Diseases, 2010.

http://www.thefreedictionary.com/relapse, Relapse, Retrieved December 26, 2010, Farlex, Inc., 2010.

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  • Jocare

    I have Hep C Genotype 3e. I went through 24 weeks of Interferon and Ribavarin. I cleared virus soon after starting treatment. I made it through treatment with help of Procrit and Neupogen. I was 60, in good health, active, and diligent. At the end of 24 weeks I still had no virus….it showed up again about 2 months later. At this time I feel there isn’t enough research of Geno type to cause me to start all over again.  I wish there was.

  • veen

    hi, i am 36, i had HCV with geno type 3a and went through 24 weeks therapy of pegasus and ribavarin. at the end of treatment virus was not detected but after 07 month again it comes back………is there any suggestion to get cured….. ?

  • jason

    hi, i had the combination therapy for 24 weeks and cleared the virus within the first 4 weeks. i have had my final blood test now after 1 year after treatment and i hope i remain clear although i do worry about relapse.i had nearly no side effects during teatment just minor headaches and itchy skin but iam suffering with memory loss which is my main concern right now,i feel not enough research is done in this area as the blood to brain barrier is not supposed to be breached. good luck to you all.

  • Timothy

    I am a G3a, in my 38th week of treatment, Pegasus 180ml/ Copegus 800mg a day. Have had a very rough ride. I have just read a report in which states my controlling the riba level in the blood increases the chance for SVR. ” The end-of-treatment ribavirin concentration predicts HCV relapse…I am going to talk to my Dr. this week and ask him about this. I think it is good news.