Therapeutic strategies in patients with hepatitis C virus infection at the University Medical Center Göttingen: a retrospective analysis of therapeutic results

Worldwide 80-160 million people are estimated to be chronically infected with the hepatitis C virus (HCV), a single stranded RNA virus. Chronic HCV infection is a leading cause of liver specific morbidity and mortality including progressive liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). It is transmitted by exposure to infectious blood or blood-derived body fluids. The primary goal is the eradication of the HCV by antiviral therapy. The purpose of this retrospective study was to investigate epidemiological, clinical-chemical and histological parameters, information regarding the course of therapy, treatment response and potential side effects during treatment from 550 patients suffering from chronic HCV infection of University Medical Center Göttingen (UMG) from 1994 to 2009. Furthermore, the influence of virus- and patient-specific factors on the success of antiviral treatment was discussed. Mean age of patients was 40.5 (± 14.06) years, 61.72% were male. The infection was transmitted in 26.90% of cases by application of blood products. 25.81% of patients acquired HCV by injecting drug use. 49.63% of the patients were infected with genotype 1, 2.72% with genotype 2 and 12.54% with genotype 3. HCC occurred on average 10.66 (± 8.77) years after initial diagnosis of infection in 12.54% of the untreated patients, 10.23% of the nonresponders and 3.57% of the responders. 4.18% of all patients died due to complications of HCV infection or HCC. 66.24% of the responders and 48.79% of the nonresponders conducted a dual combination therapy of PEG-interferon alpha and ribavirin and overall 46.86% of all treated patients achieved sustained virologic response (SVR), which was significantly associated with the level of γ-GT/ALT ratio before treatment and HCV genotype 1. New direct-acting antivirals (DAA) allow to achieve SVR in approximately 90% of cases, even in difficult to treat patients, but are not available to a majority of HCV-infected patients who often cannot afford these drugs. By detecting and combining valid, effective and noninvasive pretreatment predictors, the predictive power for the eradication of HCV infection can be increased and patients who will benefit from the more readily available dual combination therapy can thus be identified.2016-07-0