Gastroenterology. 2010 Jul 13. [Epub ahead of print] A sustained virologic response is durable in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. Swain MG, Lai MY, Shiffman ML, Cooksley WG, Zeuzem S, Dieterich DT, Abergel A, Pessôa MG, Lin A, Tietz A, Connell EV, Diago M. University of Calgary, Health Research Innovation Center, Calgary, Alberta, Canada. Abstract
BACKGROUND & AIMS: A sustained virologic response (SVR) to therapy for Hepatitis C virus (HCV) infection is defined as the inability to detect HCV RNA 24 weeks after treatment has been completed. Although small studies have reported that the SVR is durable and lasts for long time periods, it has not been conclusively demonstrated in larger studies.
METHODS: The durability of treatment responses were examined in patients who were originally enrolled in 1 of 9 randomized, multicenter trials (n=1343 patients). The study included patients who received peginterferon alfa-2a alone (n=166 patients) or in combination with ribavirin (n=1077 paients), including 79 patients with normal levels of alanine aminotransferase and 100 patients that were co-infected with HIV and HCV) and whose serum samples were negative for HCV RNA (
A question came up during one of our trainings: What is the number of liver transplants in the U.S. and what is the average cost?
According to the Milliman Research Report from 2008 (the latest year information is available):
Ir was estimated that there were 6,550 liver transplants performed in the U.S. at an average cost of $523,400 per transplant (including 30 day pre-transplant, transplant operation and 180 days post-transplant). Additionally people will have to remain on many medications for life including medications to prevent the body from rejecting the new organ. Patient survival rates were 86% at one year, 78% at three years, and 72% after 5 years. Pretty good overall survival, but of course the goal for all of us is to prevent people from getting to this stage.
The type of transplant is also interesting with 6362 from deceased donors and 268 from live liver donors – the number of live liver donors actually dropped from 323 in 2005 to 268 in 2006.
It’s amazing the strides in predicting who will and who will not respond to a certain type of drug for treatment of many conditions including hepatitis C. You have probably heard about a variation in IL28B gene that has been found to greatly increase the chances of responding to current HCV current therapy. This test indicates that people have a two-fold increased chance of responding to HCV therapy compared to those who do not have this gene variation. The test for this marker is expected to be commercially available in the next month or so. I wrote a recap of the studies about IL28B that will we will publish in the August HCV Advocate Newsletter. This marker will be a great tool in the treatment decision process.