ABSTRACT
Rapid progress in the treatment of hepatitis C virus (HCV) infection has led to highly
successful therapies that lead to viral eradication and sustained viral response in
more than 50% of patients. Despite these advances, certain identifiable subpopulations
appear to have reduced rates of treatment response. These include patients co-infected
with HCV/HIV, alcohol abusers, and African Americans infected with HCV. Using research
tools including viral kinetic modeling, factor analysis, and laboratory evaluation
of viral and host genomic characteristics, a number of key elements of response have
been identified. Examination of special populations reveals that these groups comprise
complex mixes of poor prognostic markers. These include both host and viral factors.
Use of peginterferons with ribavirin improves response rates in these groups, but
does not fully ameliorate the response deficit relative to patients enrolled in typical
drug registration clinical trials.
KEYWORDS
HCV - treatment - HIV - alcohol - race - quasispecies - viral load