Baseline High Viral Load and Unfavorable Patterns of Alanine Aminotransferase Change Predict Virological Relapse in Patients With Chronic Hepatitis C Genotype 1 or 2 Obtaining Rapid Virological Response During Antiviral Therapy

Background: rapid virological response (rvr) strongly predicts sustained virological response (svr) in patients with chronic hepatitis c (chc), and abbreviates antiviral therapy in some patients. objectives: to identify factors predicting virological relapse (vr) in chc patients who attained rvr. patients and methods: medical records of 133 chc patients with an rvr after completing 24 weeks of antiviral therapy (a combination of pegylated interferon-α and ribavirin) were analyzed. baseline characteristics and on-treatment responses were compared between the patients with an svr and those with vr. patients with normal alanine aminotransferase (alt) levels at weeks 4 and 12 and at the endof-treatment (eot) and patients with elevated, but constantly decreasing, alt levels were classified as having favorable patterns of alt change. a trend of increasing alt levels either between weeks 4 and 12 or between weeks 12 and eot was classified as unfavorable. a high viral load (hvl) was defined as a baseline hcv rna ≥ 600000 iu/ml. results: in total, 116 (87.2%) patients had a svr and 14 (10.5%) had vr. the vr rates were comparable between patients with genotype-1 (13.1%) and genotype-2 infection (8.7%) (p = 0.572). multivariate analysis revealed that hvl (p = 0.015; odds ratio [or] = 14.754; 95% confidence interval (ci) = 1.671–130.240), and unfavorable alt patterns (p = 0.039; or = 4.397; 95% ci = 1.078–17.930) independently predicted vr. in subgroup analysis, low viral load (lvl) patients had a minimal vr rate (1.8%). among the hvl patients, the vr rate of those using peg-ifn-α-2a was relatively low (9.1%). patients using peg-ifn-α-2b had a slightly higher vr rate (23.8%; p = 0.128), and patients with favorable patterns of alt changes had a lower vr rate (10.3%) compared to the 53.8% in patients with unfavorable alt patterns (p = 0.005). conclusions: in southern taiwan, 24 weeks of antiviral therapy achieved a high svr rate in patients with chc attaining rvr, except in the subgroup of patients treated with peg-ifn-α-2b with hvl and on-treatment unfavorable alt patterns.