Non-responders to previous treatment for hepatitis C

The main principle in treating chronic hepatitis C is the prevention of serious liver complications. Because curing hepatitis C virus infection has been demonstrated to prevent progression of liver disease and even promote regression of fibrosis, it remains the primary goal of treatment. However, nearly half of patients are not cured with our best treatment. Patients who failed older therapies should be treated with peginterferon and ribavirin, but those with advanced fibrosis or African heritage will have very low rates of response. Non-responders to peginterferon and ribavirin present a special challenge. If there were problems related to dosing, adherence, or access during treatment, then one can consider re-treating with the same regimen if the problems can be corrected. Otherwise, non-responders with early-stage fibrosis can observe without further treatment until newer drugs are available. Those with advanced fibrosis should consider low-dose peginterferon maintenance treatment or participation in an experimental trial. Experimental approaches include intensification of existing therapies, combination of new agents with existing drugs, long-term virus suppression, inhibition of liver fibrogenesis, and inhibition of hepatitis C RNA or hepatitis C viral enzymes.