Hepatitis C (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- Hepatitis C infection (HCV, hep C) facts
- What is hepatitis C infection?
- What is the nature (biology) of the hepatitis C virus?
- How does liver damage occur in hepatitis C infection?
- How is hepatitis C virus spread, is it contagious, and how can transmission be prevented?
- What are the symptoms of hepatitis C infection?
- What conditions outside the liver are associated with hepatitis C infection?
- What is the usual progression of chronic hepatitis C infection?
- Who is at high risk and should be tested for hepatitis C infection?
- What are the diagnostic tests for hepatitis C virus and how are they used to diagnose hepatitis C infection?
- What is the role of a liver biopsy in the management of chronic hepatitis C infection?
- What is the treatment for hepatitis C infection?
- Who should receive antiviral therapy for hepatitis C infection?
- What are the different patterns of response to antiviral treatment?
- What are the goals of therapy for hepatitis C infection?
- What are the therapy options for previously untreated patients with chronic hepatitis C infection?
- How are relapses and nonresponders treated?
- Should individuals with acute hepatitis C infection be treated?
- What are the side effects of treatment for hepatitis C infection?
- What about liver transplantation for hepatitis C infection?
- What is the current research and what is in the future for hepatitis C infection?
- Find a local Gastroenterologist in your town
What are the different patterns of response to antiviral treatment?
Treatment responses are mainly defined by results of the HCV RNA testing. Four patterns of response to antiviral treatment have been described:
- sustained virologic response,
- relapse,
- partial response, and
- no response.
Sustained virologic response: The optimal response is a sustained virologic response (SVR), defined as the absence of detectable HCV RNA in serum using a sensitive test at the end of the treatment and six months later. Most of these individuals will remain in remission (no signs of the disease) indefinitely, with no detectable hepatitis C virus RNA in the blood or liver. Moreover, follow-up biopsies show a marked reduction in inflammation and there even can be regression of scarring. Longer follow-up of these patients is necessary, however, to evaluate definitively whether sustained responders will avoid the complications of cirrhosis and live longer.
Relapse: Relapsers are patients who initially eliminate the RNA from their blood but then develop detectable RNA again shortly after discontinuing therapy. The RNA becomes detectable again within six months and usually within the first three months of stopping treatment.
Partial responders: Patients whose HCV RNA levels decline (two log decrease) but never become undetectable at 24 weeks are referred to as partial responders.
No response: Patients who have sustained levels of detectable HCV RNA during therapy are known as non-responders. Patients in whom HCV RNA becomes undetectable during the early period of treatment but reappears before the end of therapy, should probably likewise be considered non-responders. This reappearance of HCV RNA during therapy is referred to as a 'break through' of HCV.
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