Bulletin of the World Health Organization

Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis

Nathan Ford, Catherine Kirby, Kasha Singh, Edward J Mills, Graham Cooke, Adeeba Kamarulzaman & Philipp duCros

Volume 90, Number 7, July 2012, 540-550

Table 1. Effect of treatment, disease, patient and study covariates on the sustained virological responsea rate in patients with a chronic hepatitis C virus infection in low- and middle-income countries, by meta-regression analysis

Covariate No. of reportsb Univariate analysis
 Multivariate analysis
β coefficient (95% CI) P-value β coefficient (95% CI) P-value
Treatment regimen
Standard interferon22,24,26–69 44 −10.6 (−18.0 to −3.1) 0.006 −7.8 (−16.6 to 0.9) 0.07
Pegylated interferon25,26,29,33,36,38,61,63,65,67,70–115 52 Reference NA Reference NA
Ribavirin not administered22,37,40,50,56,64,85 7 27.5 (13.8 to 41.2) < 0.0001 1.6 (−21.8 to 18.6) 0.9
Ribavirin administered24–36,38,39,41–49,51,53–55,57–63,66–84,86–93,95–100,102–115 86 Reference NA Reference NA
Fixed-dose ribavirin24,26,31,45,46,58,60,66,69,71,80,82,84,97 14 1.2 (−8.5 to 10.9) 0.8 ND ND
Weight-based ribavirin25,27–30,32,33,35,36,38,39,41,42,44,47–49,51–55,57,59,61–63,65,67,68,72–79,81,83,86–93,95,96,98–115 68 Reference NA ND ND
HCV genotype
Genotype 1 or 422,26,34,37–39,54–57,63,65,67–69,72,73,76–83,85,86,88,90–94,96,97,100–107,109–111,114,115 46 −10.2 (−17.7 to −2.5) 0.01 −11.9 (−23.8 to 0) 0.005
Not genotype 1 or 424,25,27–29,32,33,35,36,41–47,50–53,58,62,66,70,71,74,75,84,87,89,95,108,110,112,113 36 Reference NA Reference NA
Liver damage at baseline
Yes33,34,36,54,55,57,58,63,65–67,69,70,75,76,79,87,88,90,92,93,95,101,104,105,115 24 −12.2 (−23.2 to −1.3) 0.03 ND ND
No26,51,64,78,98–100,108,110 9 Reference NA ND ND
HIV status
HIV-positive73,76,104 3 −32.4 (−50.5 to −14.2) 0.001 −28.9 (−45.9 to −11.9) 0.001
HIV-negative27,28,31,32,34–36,39,41,43,44,46,50–52,54,55,58,63,65,67–73,75,76,78,80,82,83,85–87,89–96,98–100,102,104–106,108,111–115 51 Reference NA Reference NA
Economic level of study regionc
Low- or lower-middle income25,27–33,36,41–43,45–48,51–53,58,62,66,71,74,75,84,87,89,105,108 30 −13.0 (−20.7 to −5.2) 0.001 −6.7 (−19.4 to 6.0) 0.3
Upper-middle income22,24,26,34,35,37–40,44,49,50,53–57,59–61,63–65,67–70,72,73,76–83,85,86,88,90–93,95–104,106,107,109–115 62 Reference NA Reference NA
Study design
Prospective22,24,25,28–32,34,35,37–39,41,43–45,47–52,55,57,58,62,66,69–75,77–80,82,84–86,88,90–93,95–102,104,105,107,108,110–112,115 65 −2.6 (−11 to 5.7) 0.5 ND ND
Retrospective26,27,33,36,40,42,46,52,54,56,59–61,63–65,67,68,76,81,83,87,89,103,106,109,113,114 28 Reference NA ND ND

CI, confidence interval; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NA, not applicable; ND, not determined.

a A sustained virological response was defined as the absence of detectable hepatitis C virus (HCV) in blood 24 weeks after the completion of antiviral therapy.

b Since one publication77 reported one study fully and gave the preliminary outcomes of a second study, the figures here could differ by 1 from those in the text.

c The level of economic development of the study country was categorized using The World Bank classification.16