[Treatment of hepatitis C virus infection]

Undetectable hepatitis C virus (HCV)-specific RNA in serum six months after the end of treatment is the primary aim of antiviral therapy in patients with chronic hepatitis C. Long-term studies confirmed that viral eradication is durable in more than 95% of cases. The high chronification rate of acute hepatitis C (50 to 80%) justifies therapeutic strategies to prevent a chronic course of the infection. Monotherapy with interferon-alpha for 24 weeks can prevent chronification in more than 90% of patients with acute hepatitis C. Antiviral therapy should be considered in all patients with chronic hepatitis C, who are symptomatic, or have a considerable risk for the development of liver cirrhosis and its sequelae, if they have no contraindication for therapy. Furthermore, treatment should be considered in all patients who carry a substantial risk to infect others. Combination therapy with a pegylated interferon-alpha plus ribavirin is the current standard of care and achieves sustained virologic response rates of 54 to 61%. Patients chronically infected with genotype HCV-1 isolates should be treated for 48 weeks (independent from baseline viral load), while in patients infected with HCV-2 or -3 isolates 24 weeks of treatment are sufficient. Patients without sustained virologic response can still benefit histologically from an interferon-alpha based therapy. Possibly, interferon-alpha also reduces the risk for patients with chronic hepatitis C to develop hepatocellular carcinoma.