Key Principles
The current standard of care for treatment of chronic hepatitis C is once weekly pegylated interferon and daily oral ribavirin. The optimal treatment regimen is determined by viral genotype, patient weight, and the initial virus response to therapy, termed early virologic response (EVR). Non-responders can be identified after the first 12 weeks of treatment so that therapy can be stopped.
Treatment of chronic hepatitis C with antiviral therapy requires close monitoring since about 30% of patients require dose modifications for cytopenia or side effects.
Approximately half of treated patients are cured of their infection. Treatment response, termed sustained viral response (SVR), is associated with resolution of inflammation and fibrosis regression. Patients with cirrhosis who achieve an SVR have no further risk of liver failure and the risk of liver cancer is markedly reduced, though not eliminated.
Some groups of patients have a lower chance of response to treatment than others. Recent studies suggest that higher doses of antiviral drugs might be of benefit in these cases. Patients with advanced cirrhosis or extrahepatic manifestations of hepatitis C infection are best treated by a physician, who has considerable experience with these drugs.
New virus-specific antiviral agents are in development but it appears that they will need to be given in conjunction with interferon and ribavirin. It is hoped that these new drugs will improve efficacy and perhaps shorten the required duration of treatment. These drugs, if approved, will probably not be available before 2010.