Feasibility of individualized treatment for hepatitis C patients in the real world

Background and Aim: Individualized treatment with a combination of peg‐interferon and ribavirin for patients with hepatitis C virus (HCV) infection has been validated in randomized controlled clinical trials, but its usefulness in the real world is unknown. The aim of the present study was to assess the feasibility of individualized treatment for HCV patients compared with standard therapy in a real‐life clinical setting. Methods: A total of 253 naïve patients with HCV infection who received peg‐interferon and ribavirin combination treatment were analyzed and grouped into one of three clinical settings: (i) infection with genotype non‐1 (HCV non‐1) and treatment for standard 24 weeks (n = 105; none received an abbreviated therapy); (ii) genotype 1 (HCV‐1) and standard therapy for either 24 weeks (n = 71) or 48 weeks (n = 21); and (iii) HCV‐1 and individualized treatment (n = 56). The individualized therapy used was an abbreviated 24‐week treatment for HCV‐1 patients who achieved a rapid virological response, otherwise patients received a 48‐week course of treatment. Early termination of treatment at week 16 was recommended for non‐responders. Results: A sustained virological response (SVR) was achieved in 83.8% of patients with HCV non‐1 infection. Among the HCV‐1‐infected patients, 53.5% of patients who underwent standard 24‐week treatment, 66.7% of patients who underwent standard 48‐week treatment, and 64.3% of patients treated by individualized therapy achieved SVR. Patients infected with HCV‐1 and treated by individualized therapy had a similar efficacy response compared with the standard 48‐week therapy (adjusted odds ratio [OR] 0.765, 95% confidence interval [CI], 0.220–2.659, P = 0.673). Both individualized therapy (adjusted OR 2.855, 95% CI 1.189–6.855, P = 0.019) or standard 48‐week treatment (adjusted OR 3.733, 95% CI 1.073–12.986, P = 0.038) had significantly higher odds of SVR compared with HCV‐1 patients treated by standard 24‐week course. Conclusion: Individualized therapy is feasible in the real world, especially for patients with HCV‐1 infection.     

Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults

BACKGROUND: The prevalence of nonalcoholic fatty liver disease (NAFLD) is rarely reported in Taiwan. GOALS: To determine the prevalence and risk factors of NAFLD in an adult population of Taiwan. STUDY: The cross-sectional community study examined 3245 adults in a rural village of Taiwan. The diagnostic criteria for NAFLD included no excessive alcohol intake, no chronic viral hepatitis, no known etiologies of liver disease, and ultrasonography consistent with fatty liver. RESULTS: The prevalence of NAFLD was 11.5% (372/3245). The risk factors for NAFLD in the general population were male sex [odds ratio (OR), 1.44; 95% confidence interval (CI), 1.09-1.90], elevated alanine aminotransferase (ALT) (OR, 5.66; 95% CI, 3.99-8.01), obesity (OR, 7.21; 95% CI, 5.29-9.84), fasting plasma glucose > or =126 mg/dL (OR, 2.08; 95% CI, 1.41-3.05), total cholesterol > or =240 mg/dL (OR, 1.50; 95% CI, 1.06-2.13), triglyceride > or =150 mg/dL (OR, 1.76; 95% CI, 1.32-2.35), and hyperuricemia (OR, 1.53; 95% CI, 1.16-2.01). Age > or =65 years was inversely related to NAFLD (OR, 0.53; 95% CI, 0.36-0.77). The only NAFLD risk factors among nonobese subjects were age between 40 and 64 years (OR, 2.35; 95% CI, 1.34-4.11, P=0.003), elevated ALT (OR, 15.45; 95% CI, 8.21-29.09, P<0.001), and triglyceride > or =150 mg/dL (OR, 2.48; 95% CI, 1.42-4.32, P=0.001). In subjects with NAFLD, the prevalence of elevated ALT in the presence of each metabolic risk factor, such as obesity, fasting plasma glucose > or =126 mg/dL, total cholesterol > or =240 mg/dL, triglyceride > or =150 mg/dL, and hyperuricemia, did not differ from that of subjects with normal ALT levels. CONCLUSIONS: NAFLD is closely associated with elevated ALT, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and hyperuricemia. Among the metabolic disorders, only hypertriglyceridemia was related to NAFLD in nonobese subjects. Serum ALT level was not a good predictor of metabolic significance in subjects with NAFLD.