Re-Treatment of patients with chronic hepatitis C virus genotype 4 infection with pegylated interferon and ribavirin: A meta-Analysis

Abstract

Background: An estimated 170 million people worldwide are infected with hepatitis C virus (HCV). HCV genotype 4 (HCV-4)-The most prevalent hepatitis C strain in the Middle East and Africa-is difficult to treat, with an estimated sustained virological response (SVR) of 53% when using pegylated interferon and ribavirin (P/R) in treatment-naïve patients with HCV-4 infection. In regions where access to direct-Acting antivirals is limited, re-Treatment of patients who failed therapy with another course of P/R may be an option if the success rate is acceptable. Objectives: We aimed to determine the SVR from retreatment with P/R in treatment-experienced patients with HCV-4 infection. Methods: We performed a meta-Analysis using MEDLINE and EMBASE searches, and by reviewing article bibliographies and abstracts from recent Liver Society Meetings. Original studies featuring at least 10 adult, treatment-experienced patients with HCV-4 infection failing prior interferon-based therapy and receiving subsequent re-Treatment with P/R were included. Results: 3 studies were included. Overall pooled SVR was 32.7%, or 41/126 patients. No significant heterogeneity existed among the studies. One study reported higher SVR of 50% in previous relapsers, compared with 23% in previous non-responders. Conclusions: As expected, treatment-experienced patients achieved lower rate of SVR compared with previously reported SVR for treatment-naïve patients with HCV-4 infection. The abysmal rate of success from re-Treatment with P/R supports the use of directacting antivirals whenever re-Treatment is considered, even in resource-limited regions.