Advances in Hepatitis -- From ICAAC 2007: An Expert Interview With Dr. Soriano

[Guest guest]

From Medscape HIV/AIDS

Advances in Hepatitis -- From ICAAC 2007: An Expert Interview With Dr.

Soriano

Posted 09/28/2007

Soriano, MD, PhD

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Medscape: I'm Dr. Maxwell Mundy, Editorial Director of the HIV/AIDS site

on Medscape, speaking from Chicago, where the 47th Conference known as ICAAC is

being held. Today I am talking with Dr. Vicente Soriano of Madrid, Spain,

regarding the most important data presented on hepatitis monoinfection. Dr.

Soriano, there were good data presented today on telaprevir and hepatitis C.

Could you outline that for us?

Dr. Soriano: Yes. I think this is new information,[1] and it concerns the

efficacy of a new protease inhibitor for hepatitis C, telaprevir, produced by

Vertex and which probably will be marketed by Tibotec. The data concern people

with genotype 1 who are naive for interferon. They were stratified in 4 groups:

a control group treated with pegylated interferon and ribavirin, and another 3

groups treated with pegylated interferon plus ribavirin plus telaprevir. The new

data showed that what we call the rapid virologic response, which is

undetectability of the hepatitis C viremia at week 4, was obtained by only 11%

of patients under the standard of care -- pegylated interferon plus ribavirin --

but was achieved in up to 79% of patients who received any of the 3 arms of

telaprevir. This is a big difference, and the interpretation of the data needs

to take into account that rapid virologic response is the best predictor of

sustained virologic response. So the fact that nearly 80% of patients on

telaprevir in the triple combination can reach rapid virologic response may

represent a huge change in the outcome of patients treated for hepatitis C. We

are talking about genotype 1 patients -- the difficult-to-treat ones.

Medscape: Thank you. The other interesting paper on monoinfection dealt with

hepatitis B in vaccine escape. Can you outline that paper for us?

Dr. Soriano: Yes. This is a paper from France, and this paper highlights the

implication of mutations in the polymerase in hepatitis B, as we have available

more and more antivirals for hepatitis B -- right now lamivudine, adefovir,

entecavir, and telbivudine plus emtricitabine and tenofovir as compassionate-use

agents.

So what would be the impact of selecting viruses with resistance mutations in

the polymerase when we know that the envelop gene of hepatitis B overlaps with

the polymerase gene? The fact is that some mutations in the polymerase gene may

affect the antigenicity of the surface antigen, producing either lack of

recognition in diagnostic tests -- what we call occult hepatitis B -- or maybe

would fail to be protected by the vaccine. We are using the regular vaccine to

immunize people who have not been exposed to hepatitis B. [The study authors]

emphasize that we need to be aware of this as a potential problem -- that this

may represent a public health concern in the future.

Supported by an independent educational grant from Bristol-Myers Squibb

http://www.medscape.com/viewarticle/563489?src=mp

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