HCV RNA decline in chronic HCV genotype 2 and 3 during standard of care treatment according to IL28B polymorphism

Summary The IL28 gene is highly associated with sustained viral response (SVR) in patients infected with genotype 1 after standard of care (SOC) treatment with peg‐IFN and ribavirin. It is also associated with a steeper first phase HCV RNA decline during treatment. In genotype 2 and 3 infections, these correlations are less obvious. We studied the IL28B association to rapid viral response (RVR), SVR, first and second phase HCV RNA decline during treatment in 100 HCV mono‐infected and 13 HCV/HIV co‐infected patients. We found a significantly higher mean baseline HCV RNA level in IL28B SNP CC than non‐CC mono‐infected patients, 6.99 vs 6.30 log10 IU/mL (P = 0.02), and a significantly larger median 1st phase decline in patients with CC than non‐CC genotype, 2.03 vs 1.37 log10 IU/mL, respectively. The overall SVR rate in HCV mono‐infected patients was 87% vs 77% in HCV/HIV co‐infected patients, with no correlation to IL28B SNP. In mono‐infected patients with RVR, the SVR rate was high and independent of IL28B genotype. In mono‐infected patients who failed to achieve RVR who had IL28B CC and non‐CC genotype, 64% and 67% achieved SVR, respectively. In genotype 2 and 3 infected patients, the 1st phase HCV RNA decline was steeper in patients with IL28B CC vs non‐CC genotype during SOC treatment. This did not translate into a higher frequency of RVR or SVR. Hence, the clinical relevance of pretreatment analysis of IL28B polymorphisms in genotype 2 and 3 infected patients can be questioned in patients with expected high SVR rate.