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September 17, 2003

Clinical Aspects of Chronic Hepatitis C InfectionClinical Aspects of Chronic Hepatitis C Infection

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(11):1452. doi:10.1001/jama.290.11.1452-a

To the Editor: Dr Flamm1 briefly addressed the question of whether medication should be discontinued early in patients with HCV who do not respond early to treatment. Early virologic response, defined as a minimum 2 log decrease in viral load during the first 12 weeks of treatment, is predictive of sustained virologic response.2 Flamm recommended stopping treatment if quantitative HCV-RNA titers do not decline by more than 2 logs by week 12 of therapy, in patients infected by either genotype 1, 2, or 3. Patients with genotype 1 who fail to achieve an early response at week 12 of treatment have only a small chance of achieving a sustained response even if therapy is continued for a full year.3 However, patients infected by genotype 2 or 3 have a high probability of a sustained response.3 Thus, viral-RNA quantification at 12 weeks does not seem warranted in either of these situations. Rather, it seems more logical to assess virological response (disappearance of viral RNA) at the end of treatment (24 weeks).4 HCV-RNA testing to assess early virologic response is not cost-effective in patients with genotype 2 or 3; Davis5 has suggested that these patients should receive 24 weeks of treatment regardless of early response.

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