Treatment of chronic hepatitis C infection: one step at a time

Non-A, non-B hepatitis was recognised as an important cause of chronic liver disease long before the aetiological agent-hepatitis C virus-was identified in 1989. Recombinant interferons, initially developed as a treatment for malignancies, proved to be an effective treatment for this disease before the identification of the viral agent. Subsequent testing for hepatitis C virus RNA demonstrated that the virus appeared to be eradicated in a small proportion of treated patients. Treatment regimens have improved dramatically since 1989 with the addition of the oral nucleoside ribavirin and long-acting pegylated interferons to treatment regimens. Currently, more than half of treated patients can achieve durable viral clearance. This clearance is quite a remarkable feat; indeed, eradication is not possible in any other chronic viral infection. Considerable effort continues to be devoted to improving therapeutic regimens to make them more effective and tolerable. Drugs that directly act on the replicative machinery of the virus-protease and polymerase inhibitors-are under development and entering clinical trials in human beings.