Influence of HCV Genotype 1 Subtypes on the Virus Response to PEG Interferon Alpha-2a Plus Ribavirin Therapy

New factors that influence the viral response in HCV non-genotype 2/3 patients must be identified in order to optimize anti-HCV treatment. This multicenter prospective study evaluates the influence of HCV variability and pharmacological parameters on the virological response of these patients to pegylated interferon alpha 2a (peg-1FN-alpha 2a: 180 mu g/week) and ribavirin (RBV; 800-1,200 mg/day) for 48 weeks. HCV subtypes were identified by sequencing the NS5B region. Serum RBV and peg-IFN-alpha 2a concentrations were measured at weeks 4 and 12. The 115 patients (67 men; median age = 49, range 31-76) included 64 who had never been treated and 27 co-infected with HIV. The mean baseline HCV RNA was 6.30 +/- 0.061og IU/ml and the HCV genotypes were: G1 (n=93) with 1a (n=37) and 1b (n=50), G4 (n = 20) and G5 (n = 2). Most patients (79/108; 73%) had an early virological response. Independent predictors of an early virological response were interferon naive patients (OR = 2.98, 95% Cl: 1.15-7.72) and RBV of > 2,200 ng/ml at week 12 (OR = 3.41, 95% Cl: 1.31-8.90). Forty of 104 patients (38%) had a sustained virological response. The only independent predictors of a sustained virological response were subtype lb (OR= 6.82, 95% Cl: 1.7-26.8), and HCV RNA < 15 IU/ml at week 12 (OR = 25, 95% Cl: 6.4-97.6). Thus a serum RBV concentration of > 2,200 ng/ml was associated with an early virological response and patients infected with HCV subtype lb had a better chance of a sustained virological response than did those infected with subtype 1a. J. Med. Virol. 83:437-444, 2011. (C) 2011 Wiley-Liss, Inc.