Therapeutic Response of Black Africans in the Treatment of Genotype 2 Chronic Viral Hepatitis c by Pegylated Interferon-ribavirin

Research Article

Austin J Gastroenterol. 2014;1(2): 1009.

Therapeutic Response of Black Africans in the Treatment of Genotype 2 Chronic Viral Hepatitis c by Pegylated Interferon-ribavirin

Njoya O1,2*, Ntsama L1, Essi MJ1, Kowo M1,2, Luma H2, Tzeuton C2, Tagni M2, Dang I2, TallaP2, Kamto D2, Amadou2, Oloumou S2, Leundji H2, Fondjo M2, Noah D2, Malongue A2, Taku2, kamdoum M2 and Ndjitoyap Ndam EC2

1Department of Medicine and Biomedical Sciences University of Yaoundé I, Cameroon

2Cameroon Network against viral hepatitis, Cameroon

*Corresponding author: :Njoya O, Department of internal medicine and specialties, university of Yaoundé I, Research Laboratory on viral hepatitis and Health Communication, Po. Box 3495 Yaoundé, Cameroon

Received: June 20, 2014; Accepted: July 23, 2014; Published: July 25, 2014


Background: Although genotype 2chronic hepatitis C (CHC2) is usually credited with very good responses, data from sub Saharan Africans are poorly documented.

Aim: To characterize the response to Pegylated interferon alpha 2a, and ribavirin in the sub-Sahara.

Methods: Patient Selection: We consecutively included consented CHC2 treatment-naÏve adults from all treatment centers in Cameroon. Eligible patients, free from any other chronic liver disease or HIV infection, were required to have a serum viral load of at least 2000 copies HCV RNA/mL, and a level of fibrosis of F2 or higher.

Study design: The medical records of patients who sought treatment were systematically reviewed by a committee. Efficacy was assessed by rapid virological response (RVR); early virological response (EVR); end of treatment response (ETR); and sustained virological response (SVR). Adverse events were recorded monthly. Data were analyzed using χ2 and Fisher’s exact tests as appropriate.

Results: We included 102 patients aged 42 to 71 years. Risk factors of transmission were dominated by past history of invasive surgery, RVR was achieved by47% of patients; EVR by 88.2%; and ETR by 74.5%. Twenty seven patients relapsed; we ended with a SVR in 48% of patients. The viral kinetic showed a slow reaction to treatment.

Conclusion: The therapeutic response to Pegylated interferon ribavirin combination of blacks from the sub-Sahara, with CHC2 is by far lower than in Caucasians, Black Africans seem to react more slowly to therapy. Pending the arrival of new drugs, therapeutic protocols need to be reconsidered.

Keywords: Chronic hepatitis C; Genotype2; Sub-Sahara; Therapeutic response


Even though genotype2 chronic hepatitis C (CHC2) is usually credited of very good response, empirically, we noticed occurrence of relapses. By the way the results of some studies have highlighted racial differences in therapeutic response; meanwhile the response to therapy in sub Saharan Africans is still poorly documented. According to WHO, Cameroon has one of the highest prevalence of infection by hepatitis C virus (HCV) in the world and the highest prevalence in sub-Sahara. The treatment of CHC so far available in this part of the world, is the combination of Pegylated interferon and ribavirin, even though not affordable by the majority of patients suffering from CHC. Racial differences have been reported in some countries but data from sub Saharan countries, where most of the patients in the world are found, are still not that available. We carried out this study with the aim to determine the therapeutic response to the classical treatment of CHC2 in a sub Saharan country with high prevalence of HCV infection.


Patient selection

We consecutively included in the study, adult Cameroonian patients, naÏve of any treatment against CHC. CHC2 patients were selected from all the centers of treatment of CHC in Cameroon. We included in this study, CHC2 patients who did have neither any other chronic liver disease, nor HIV infection. The patients should have a viral load of at least 2000 copies HCV ARN/mL of serum. The level of fibrosis should be F2 and above. By the way patients should full filed all the conditions of a treatment by Pegylated interferon alpha 2a (peg-inf) and Ribavirin according to manufacturer. We used Roche manufactured peg-inf and Ribavirin. Patients should have completed 24 weeks of treatment.

Study design

The medical records of patients who sought treatment were systematically reviewed by a committee. After eligibility, inclusion required informed consent. Data collected from the different treatment centers were centralized for analysis. Data from patients treated for 24 weeks with weekly 180 μg peg-inf interferon alpha 2 (peg inf) Subcutaneous plus daily oral ribavirin at a dose of 1000 mg for patients weighing up to 75 kg, and 1200 mg per day for those weighing more than 75 kg were included in the analysis. Patients were followed up during external consultation, through analysis of biological records and adverse events analysis. Medical and psychological assistance were given as appropriate.

Assessment of efficacy

Efficacy was assessed by measurement of serum HCV RNA at Weeks 4, 12 and 24 of treatment and 24weeks after the end of treatment, to assess rapid virologic response (RVR), early virologic response (EVR), end of treatment response (ETR) and sustained virologic response (SVR), respectively. The primary efficacy endpoint was SVR, defined as the absence of detectable HCV RNA in the serum. The serum HCV RNA was measured using a real time Taq Man Roche reverse-transcription-polymerase chain reaction assay. The sensitivity was 15 IU (1.2 log IU) per mL.

Assessment of safety

During follow up, safety was assessed by laboratory tests. There was a monthly (4weeks) recording and evaluation of adverse events. If required, this period of time could be shortened.

Statistical analysis

Bivariate and multivariate analyses were performed, using χ2 and Fisher’s exact tests as appropriate. A P value of less than 0.05 was used to indicate statistical significance.


Patient’s characteristics

We included a total of 102 patients, of whom 68 were males and 34 females. Their age ranged from 42 to 71 years, with a mean of 58.1±8.6 years. The most-represented age group was that of 55-65 years.

Based on self-reporting, the dominant assumed risk factor of transmission was past history of invasive surgery, followed by scarifications, tattoo and piercing; 20% of patients had no apparent risk factor. Diabetes and obesity were common comorbidities. Fifty two percent of patients had severe fibrosis, assessed by biological indirect method or liver biopsy; with regard to virology, 71% of patients presented with a high baseline viral load. ALT was normal in one third of patients (Table 1).