[Treatment of chronic hepatitis C]

Since last 5 years there have been several important advances that significantly impact therapy. The most notable advances have been the availability of sensitive, specific, and standardized tests for identifying hepatitis C virus (HCV) RNA in the serum, the addition of ribavirin to alpha interferon, the pegylation of alpha interferon, and the demonstration that sustained virological response (SR) is the optimal surrogate endpoint of treatment. The combination of high-dose peginterferon and ribavirin is more efficacious than standard interferon and ribavirin in persons infected with HCV genotype 1 (Genotype HCV1 patients may show SR of about 40%.) Compensated HCV cirrhosis patients may also be treated with PEG-IF and ribavirin combination. Decompensated cirrhosis needs liver transplantation. Strategies to enhance response to current therapies include the development of novel interferons, nucleoside analogues, inosine 5' monophosphate dehydrogenase inhibitors, and other immunomodulators that are being evaluated as adjunctive therapy to interferon-based regimens.