AIDES MOI

Check HCV viral load (RNA) for treatment response.

This is mainly still a research test, but more doctors are beginning to use it

Improving liver health

A secondary goal of HCV treatment is to improve liver health by
reducing inflammation, and sometimes, reversing fibrosis. This even
happens in patients who do not have an SVR, although only in
about half the number of cases.
In some cases, the condition of the liver may worsen after HCV
treatment, particularly among people who did not clear the virus;
the reasons for this are unclear.

Reducing Risk of HCV Progression

Studies of people with HCV and HIV/HCV have reported that HCV
treatment reduces the risk of complications (cirrhosis, liver cancer,
and liver-related death), especially for people who have an SVR.
For HCV/HIV-coinfected people, there may be an additional benefit
from HCV treatment: less risk of liver-related side effects from HIV drugs.
Predicting the response to treatment
Several factors can help you predict the likelihood of HCV treatment
response, but the only way to know how you will respond is to treat.
The most significant factors are:
Early response to HCV treatment (see box, page 44)
HCV genotype (2 and 3 are more sensitive to treatment than
1 or 4);
HCV viral load (treatment is more effective with an HCV viral
load below 400,000 IU/mL);
Race (treatment is less effective for African Americans; ongoing
research is looking at this question);
Amount of liver damage and steatosis (treatment is less
effective for cirrhotics and people with steatosis);
HIV status (treatment is less effective for HIV-positive people
than for HIV-negative people);
Insulin resistance and diabetes (these are both more common
among people with HCV versus the general population; HCV
treatment is less effective for people with these conditions;
researchers are studying the effect

Evaluating the response to treatment

The response to HCV treatment is measured by HCV viral load tests at different times.
SVR (sustained virological response): An SVR means that HCV is not detectable in blood six
months after completing treatment. Many experts think of SVR as a cure, and it is an indication of
long-term remission. SVR rates are usually the most important results to look for from a clinical trial.
SVR-12: An SVR-12 means that no hepatitis C virus is detectable in blood three months after
completing treatment. Hepatitis C virus is most likely to re-emerge within 12 weeks after finishing
HCV treatment, so SVR-12 is considered a good predictor of SVR. However, experts agree that
more data are needed before it can replace SVR. SVR-12 is often used for reporting results of
new HCV treatments at medical conferences.

EVR (early virological response): An EVR means that the hepatitis C viral load has dropped by
99% (2 logs), or is undetectable after 12 weeks of treatment. Someone who does not have an
EVR has only a very low chance of getting an SVR (only 1% to 4% chance). Usually, people
choose to discontinue hepatitis C treatment if they do not have an EVR.
pEVR (partial early virological response): A partial early virological response means that a
persons HCV viral load has dropped by at least 99% (2 logs) after 12 weeks of treatment.
cEVR (complete early virological response): A complete early virological response means that
the hepatitis C viral load is undetectable after 12 weeks of HCV treatment. People with cEVR are
more likely to have an SVR than people with pEVR.
ETR (end-of-treatment response): An end-of-treatment response means that no hepatitis C virus
is detectable by an HCV viral load test at completion of therapy. Some people with an ETR will
see HCV viral load return, usually within 12 to 24 weeks after they have stopped treatment.
Relapser: The term relapser refers to someone who became, and remained undetectable during
treatment, but hepatitis C virus rebounded after finishing treatment.
Viral Breakthrough: This means that HCV reemerges during treatment, after having been
undetectable.
Partial Responder: The term partial responder refers to someone who had at least a 99% (2 log)
drop in HCV viral load during treatment.

Non-responder: Non-responder is a general term for someone who does not have an EVR, or if
they stay on treatment for 24 weeks, does not ever have a 99% drop in viral load or undetectable
HCV RNA while on treatment.
Null Response: The term null response means that there was little or no change in HCV viral
load during treatment.
RVR (rapid virological response): An undetectable HCV viral load after four weeks of treatment
is called a rapid virological response (RVR). RVR is a good predictor of an SVR later. However,
RVR is not good for predicting who is unlikely to respond, so treatment should not be stopped if
there is no RVR. RVR is mainly used in research, but doctors are beginning to use it outside of
studies.