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The sustained viral response rate (SVR) is 36-41
following a 24- or 48-week course of therapy. In general, patients with the
genotype 1 infection should receive 48weeks of therapy, and those with
genotypes 2 or 3 infection only 24weeks.
Viral load estimations are
problematic because of normal fluctuations (up to 0.5-10 log), assay
variability and lack of a universally accepted standard; thus, viral load
testing is not recommended routinely at present.
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The sustained viral
response rate produces improvements in quality of life and liver histology
(including reversal of bridging fibrosis and cirrhosis is some), and durable
responses lasting 5-11years in 95-97 of cases.
While the optimal dose of
ribavirin is currently unknown, available data suggest that higher doses
increase efficacy (albeit with a greater degree of anemia). The dose of
800mg/day may be the most appropriate lower dose for those patients who
require
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dosage modification for anemia or other side-effects. Patients who
have relapsed after interferon monotherapy can be successfully retreated
with higher doses of interferon for 1year or the combination of interferon
and ribavarin for 24-48weeks.
Preliminary data suggest that patients with an
unfavorable profile, including those with genotype 1 infection, should
probably be retreated with interferon and ribavirin for 48 rather than
24weeks. With our current best therapies, the majority of patients still do not
achieve the benefits of a sustained response. Re-treatment with interferon
and ribavirin may achieve a sustained response in approximately 10-25 of
these patients. In the immediate future, once-weekly pegylated interferons
will replace standard interferons.
Initial data suggest that SVR achieved
with these drugs in combination with ribavirin is increased to 54-61, but
dose modifications and side-effects are more frequent. They will thus
provide an incremental benefit in terms of efficacy, particularly for
genotype 1-infected patients.
© 2002 Blackwell Publishing Asia Pty Ltd
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