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Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis

Identifieur interne : 003461 ( Main/Exploration ); précédent : 003460; suivant : 003462

Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis

Auteurs : Nathan Ford [Suisse] ; Catherine Kirby [Suisse] ; Kasha Singh ; Edward J. Mills [Canada] ; Graham Cooke ; Adeeba Kamarulzaman [Malaisie] ; Philipp Ducros

Source :

RBID : PMC:3397704

Abstract

AbstractObjective

To assess the effectiveness of treatment for hepatitis C virus (HCV) infection in low- and middle-income countries and identify factors associated with successful outcomes.

Methods

We performed a systematic review and meta-analysis of studies of HCV treatment programmes in low- and middle-income countries. The primary outcome was a sustained virological response (SVR). Factors associated with treatment outcomes were identified by random-effects meta-regression analysis.

Findings

The analysis involved data on 12 213 patients included in 93 studies from 17 countries. The overall SVR rate was 52% (95% confidence interval, CI: 48–56). For studies in which patients were predominantly infected with genotype 1 or 4 HCV, the pooled SVR rate was 49% (95% CI: 43–55). This was significantly lower than the rate of 59% (95% CI: 54–64) found in studies in which patients were predominantly infected with other genotypes (P = 0.012). Factors associated with successful outcomes included treatment with pegylated interferon and ribavirin, infection with an HCV genotype other than genotype 1 or 4 and the absence of liver damage or human immunodeficiency virus infection at baseline. No significant difference in the SVR rate was observed between weight-adjusted and fixed-dose ribavirin treatment. Overall, 17% (95% CI: 13–23) of adverse events resulted in treatment interruption or dose modification, but only 4% (95% CI: 3–5) resulted in treatment discontinuation.

Conclusion

The outcomes of treatment for HCV infection in low- and middle-income countries were similar to those reported in high-income countries.


Url:
DOI: 10.2471/BLT.11.097147
PubMed: 22807600
PubMed Central: 3397704


Affiliations:

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<title>Methods</title>
<p>We performed a systematic review and meta-analysis of studies of HCV treatment programmes in low- and middle-income countries. The primary outcome was a sustained virological response (SVR). Factors associated with treatment outcomes were identified by random-effects meta-regression analysis.</p>
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<p>The analysis involved data on 12 213 patients included in 93 studies from 17 countries. The overall SVR rate was 52% (95% confidence interval, CI: 48–56). For studies in which patients were predominantly infected with genotype 1 or 4 HCV, the pooled SVR rate was 49% (95% CI: 43–55). This was significantly lower than the rate of 59% (95% CI: 54–64) found in studies in which patients were predominantly infected with other genotypes (
<italic>P</italic>
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