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REPLY
Hepatitis C Virus Genotype, Hepatitis C Virus RNA Titers, and Response to Interferon
Nizar N. Zein, MD, and
Jorge Rakela, MD
1 July 1997 | Volume 127 Issue 1 | Page 89
IN RESPONSE:
We have made an observation similar to the one described by Taliani and colleagues. In 60 patients with chronic HCV infection, we found that HCV genotype was a better predictor of response to interferon-
2b than was pretreatment HCV RNA level measured by first-generation branched-DNA assay (Quantiplex, Chiron Corp., Emeryville, California). Patients infected with HCV genotype 2b had lower HCV RNA levels than patients infected with genotypes 1a or 1b; these differences were statistically significant. On the other hand, excellent studies by other investigators [1, 2] showed a clear ability of pretreatment HCV RNA values to distinguish persons who did respond to interferon from those who did not.
These discrepancies could be explained by difference in the study methods used or may suggest the presence of other factors, such as age, sex, histologic findings, hepatic iron concentration, and HLA, that influence response to interferon treatment. Many of the studies to date (including ours) were done using stored serum samples, which may underestimate HCV RNA level [3], or used a first-generation branched-DNA assay that has been shown to be influenced by the genetic heterogeneity of HCV. In addition, most previous studies evaluated the value of HCV RNA level in predicting response to interferon without accounting for the other possible cofactors mentioned above. Future studies should provide multivariate analysis of these factors simultaneously to allow useful guidelines for interferon treatment.
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Author and Article Information
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Mayo Clinic and Foundation; Rochester, MN 55905
University of Pittsburgh; Pittsburgh, PA 15213-2582
1. Yamada G, Takatani M, Kishi F, Takahashi M, Doi T, Tsuji T, et al. Efficacy of interferon alfa therapy in chronic hepatitis C patients depends primarily on hepatitis C virus RNA level. Hepatology. 1995; 22:1351-4.
2. Toyoda H, Nakano S, Kumada T, Takeda I, Sugiyama K, Osada T, et al. Comparison of serum hepatitis C virus RNA concentration by branched DNA probe assay with competitive reverse transcription polymerase chain reaction as a predictor of response to interferon- therapy in chronic hepatitis C. J Med Virol. 1996; 48:354-9.
3. Halfon P, Khiri H, Gerolami V, Bourliere M, Ferym JN, Reynier P, et al. Impact of various handling and storage conditions on quantitative detection of hepatitis C virus RNA. J Hepatol. 1996; 25:307.
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