Management of patients with chronic hepatitis C virus infection and previous nonresponse

The treatment of patients with chronic hepatitis C virus infection has improved dramatically over the past several years. Despite this, more than half of all patients with genotype 1 fail to achieve a sustained virologic response (SVR) following therapy. The decision to retreat a nonresponder should balance two major factors: the likelihood that the patient will achieve an SVR during retreatment and the likelihood that the patient will develop progressive fibrosis and cirrhosis within the next 5 to 10 years (before more effective therapy is developed). Recent data have demonstrated that about 18% of all patients with previous nonresponse to standard interferon therapy (with or without ribavirin) will achieve an SVR when retreated with peginterferon and ribavirin. However, no therapy has been shown to be effective for patients with nonresponse to peginterferon and ribavirin. The approach to such patients is based on correcting the factors that led to this nonresponse. Maintenance peginterferon therapy is currently being explored but is likely to be of benefit in only a select group of nonresponders. The management of patients who have failed to achieve SVR is, therefore, one of the most complicated issues in the spectrum of treating chronic hepatitis C. This article reviews the factors to consider when assessing nonresponders for additional therapy and options for patients with continued nonresponse.