Factors that Raise the Risk of Hepatitis C Relapse
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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:
- Being infected with Hepatitis C genotype 1
- Having a significant amount of liver steatosis
- Receiving a reduced dose of pegylated interferon
- Being obese
- 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.
