Extended therapy duration for therapy-refractory hepatitis C patients with genotype 2

Abstract

We devised an extended 72-wk peginterferon-α-2a/ribavirin therapy regimen for the retreatment of highly intractable cases, i.e., 48-wk peginterferon-α-2b/ribavirin therapy-intractable cases. Although 2 cases achieved a rapid virological response to 72-wk peginterferon-α-2a/ribavirin therapy, 1 case failed to achieve a sustained virological response. Although the reason for this difference in the effectiveness of 72-wk peginterferon-α-2a/ribavirin therapy between the cases was unclear, the rebound phenomenon of serum transaminase after 48-wk peginterferon-α-2b/ribavirin therapy and the resultant lower viral load compared to that before 48-wk peginterferon-α-2b/ribavirin therapy might have influenced the treatment outcome. Thus, it may be beneficial to consider the rebound phenomenon of serum transaminase and the changes in viral load resulting from previous interferon-based therapy and then cautiously determine the indication and the timing of the administration of 72-wk peginterferon-α-2a/ribavirin in highly intractable cases. Further studies should be performed to confirm this strategy.

Keywords: Hepatitis C; Genotype 2 and high viral loads; Interferon-based therapy; Highly intractable case; Extended therapy duration

Core tip: The optimal therapy for 48-wk peginterferon-α-2b/ribavirin therapy-intractable hepatitis C patients with genotype 2 and high viral loads remains unknown. Our cases are notable in that 72-wk peginterferon-α-2a/ribavirin therapy may have been effective for these highly intractable cases. Additionally, the rebound phenomenon of serum transaminase after the 48-wk peginterferon-α-2b/ribavirin therapy and the resultant lower viral load compared to that before the 48-wk peginterferon-α-2b/ribavirin therapy might have influenced the treatment outcome. Thus, our cases highlight the importance of the results of the previous 48-wk peginterferon-α-2b/ribavirin therapy in the indication and timing of the administration of 72-wk peginterferon-α-2a/ribavirin in highly intractable cases.