There is bad news for those of us finally comfortable with the terms and abbreviations of the hepatitis C virus lexicon, like rapid virological response (RVR) and complete early virological response (cEVR). A new consensus is emerging that more precise nomenclature is needed in this era of direct-acting antivirals (DAA) (Hepatology 2012; 56: 2398-2403).
The problem is that with the use of DAA, drugs that use a 4-week lead-in have their RVR checked at 8 weeks rather than 4 weeks. Similar problems are present with the other terminology in current use.
RVR should be reported as W4U-tnd. W4 indicates week 4, U indicates viremia unquantifiable, tnd indicates whether target HCV RNA was not detected (td indicates detected). If there is a lead-in, then LI-w/d-W8U-tnd.
Other terms:
- vRVR or very rapid virological response is now W2U-tnd
- eRVR or extended RVR refers to undetectable HCV RNA at week 4 and 12 and is now W4-12U-tnd
- cEVR refers to undetectable HCV RNA at 12 weeks is now W12U-tnd
- pEVR or partial EVR indicates at least 2 log10 decrease in HCV RNA after 12 weeks of treatment. New lingo: W12[-2]
- SVR or sustained virological response is now SVR12-tnd (if 12 weeks after Rx) and SVR24-tnd (if undetectable HCV RNA 24 weeks after Rx)
- LLOQ indicates the lower limit of quantitation. A value <LLOQ is not necessarily “undetectable.”
You may need the hepatology ‘rosetta’ stone session before your next meeting with your liver expert.
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