Current Treatment for Chronic Hepatitis C

The number one choice for treatment of chronic hepatitis C is the combination of once weekly subcutaneous pegylated interferon plus daily oral ribavirin. The duration of treatment and dose of ribavirin must be tailored to the hepatitis C virus (HCV) genotype. Patients infected with HCV genotype 1 should be treated for 48 weeks with a standard dosage of ribavirin (1000 or 1200 mg/d). This ribavirin dosage regimen is 'off-label' when used in conjunction with pegylated interferon alfa-2b (12 kD). The approved dosage for use in combination with this agent is 800 mg daily. The appropriate duration of treatment and dosage of ribavirin for patients infected with HCV genotype 2 or 3 differs depending on the pegylated interferon that is chosen. It is important to note that the treatment paradigm for these individuals is quickly evolving. When using peginterferon alfa-2a (40 kD) in patients with HCV genotype 2 or 3, the duration of treatment should be 24 weeks in combination with a low dose of ribavirin (800 mg/d). When using pegylated interferon alfa-2b (12 kD) in patients infected with HCV genotype 2 or in patients infected with genotype 3 and hepatitis C virus RNA less than 600,000 IU/mL, the duration of treatment should be 24 weeks. However, recent data suggest such treatment may not be optimal for patients infected with HCV genotype 3 and hepatitis C virus RNA at levels greater than or equal to 600,000 IU/mL; treatment duration may need to be greater than 24 weeks. When using pegylated interferon alfa-2b (12 kD) in patients infected with HCV genotype 3 and high viral load, the optimal dosage of ribavirin appears to be 800 to 1400 mg/d based on bodyweight.