Prediction of week 4 virological response in hepatitis C for making decision on triple therapy: The optim study

Background: Virological response to peginterferon + ribavirin (P+R) at week 4 can predict sustained virological response (SVR). While patients with rapid virological response (RVR) do not require triple therapy, patients with a decline <1log₁₀ IU/ml HCVRNA (D1L) should have treatment discontinued due to low SVR rate. Aim: To develop a tool to predict first 4 weeks' viral response in patients with hepatitis C genotype 1&4 treated with P+R. Methods: In this prospective and multicenter study, HCV mono-infected (n=538) and HCV/HIV coinfected (n=186) patients were included. To develop and validate a prognostic tool to detect RVR and D1L, we segregated the patients as an estimation cohort (to construct the model) and a validation cohort (to validate the model). Results: D1L was reached in 509 (80.2%) and RVR in 148 (22.5%) patients. Multivariate analyses demonstrated that HIV co-infection, Forns' index, LVL, IL28B-CC and Genotype-1 were independently related to RVR as well as D1L. Diagnostic accuracy (AUROC) for D1L was: 0.81 (95%CI: 0.76-0.86) in the estimation cohort and 0.71 (95%CI: 0.62-0.79) in the validation cohort; RVR prediction: AUROC 0.83 (95%CI: 0.78-0.88) in the estimation cohort and 0.82 (95%CI: 0.76-0.88) in the validation cohort. Cost-analysis of standard 48-week treatment indicated a saving of 30.3% if the prognostic tool is implemented. Conclusions: The combination of genetic (IL28B polymorphism) and viral genotype together with viral load, HIV co-infection and fibrosis stage defined a tool able to predict RVR and D1L at week 4. Using this tool would be a cost-saving strategy compared to universal triple therapy for hepatitis C.