Chronic hepatitis C virus (HCV) infection is a major cause of cirrhosis, hepatocellular carcinoma (HCC), and end-stage liver disease. The incidence of HCV-related cirrhosis and its complications is expected to increase in upcoming years.^1,2 Davis et al² estimated that currently 25% of the approximately 3.5 million US patients with chronic HCV infection have cirrhosis and that the proportion of patients with cirrhosis is likely to increase up to 45% by 2030.

Read the full review for this F1000Prime recommended article: Sustained virologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis.

Therapy with pegylated interferon (PEG-IFN)–alfa results in sustained response in a minority of patients with chronic hepatitis B virus (HBV) infection and has considerable side effects. We analyzed data from the 2 largest global trials of hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B to determine which are most likely to respond to PEG-IFN–alfa therapy. The study included 542 patients treated with PEG-IFN–alfa-2a (180 μg/wk, 48 wk) and 266 patients treated with PEG-IFN–alfa-2b (100 μg/wk, 52 wk). Eighty-seven patients were excluded, leaving 721 patients for analysis. A sustained response was defined as HBeAg loss and HBV-DNA level less than 2.0 × 10³ IU/mL 6 months after treatment. Logistic regression analysis was used to identify predictors of sustained response and a multivariable model was constructed. HBV genotype, high levels of alanine aminotransferase (ALT; ≥2 × upper limit of normal), low levels of HBV DNA (30%) of a sustained response. The strongest predictors of response were a high level of ALT in genotype B patients and a low level of HBV DNA in genotype C patients. Genotype D patients had a low chance of sustained response, irrespective of ALT or HBV-DNA levels. The best candidates for a sustained response to PEG-IFN–alfa are genotype A patients with high levels of ALT or low levels of HBV DNA, and genotypes B and C patients who have both high levels of ALT and low HBV DNA. Genotype D patients have a low chance of sustained response.