Hepatitis C: who should you treat and how?

At present the treatment of hepatitis C virus infection (HCV) has improved because of combined treatment with interferon (IFN) and ribavirin. The association of these two drugs has obtained a positive response in 40-50% of naive patients treated. Patients with relapse after monotherapy with IFN also show positive response with combined treatment in up to about 50% of patients with HCV genotype 1b. In patients with other genotypes the response is higher (up to 70%). In nonresponders to IFN alone, the response to combined therapy was higher although there is scarce data reporting this. Similar results were achieved in cirrhotic patients. The use of pegylated IFN has shown even greater efficacy. Sustained response was greater than 50%. Lastly, triple therapy with IFN, ribavirin and amantadine has been studied in small clinical trials in nonresponders to IFN monotherapy, with controversial results since in some studies sustained response was up to 48% being less than 20% in other studies.