[Retreatment of patients with chronic hepatitis C]

Impressive gains have been made in the treatment of chronic hepatitis C virus (HCV) infection during the past decade. As the treatment for chronic hepatic C has improved, the question has arisen as to whether patients who failed previous HCV treatment regimens should be retreated. Several recent studies involving retreatment have established that a small but significant increase in sustained virologic response (SVR) resulted when nonresponders to prior interferon monotherapy were retreated with interferon and ribavirin. Given the superior results observed with pegylated interferon and ribavirin in the treatment of naive population, it is now appropriate to consider whether retreating previous relapsers and nonreponders, particularly nonresponders to conventional interferon and ribavirin, will be effective. Such treatment would be most advantageous for patients with advanced fibrosis or cirrhosis who are at the highest risk of developing complications of advanced liver disease, including hepatocellular carcinoma. Namely, there is no doubt that interferon-based regimens may reduce hepatic inflammation in the abscence of SVR. For this reason, patients with advanced liver disease receive histologic benefit from therapy in addition to the potential benefit of viral eradication, because progression of fibrosis to cirrhosis is a function of hepatic inflammation. A number of investigator-initiated clinical trials have been started to study response in prior nonresponders and relapsers retreated with pegylated interferon and ribavirin. From the data obtained from these trials, so far is clear that combined therapy can clear HCV-RNA in a significant number of prior nonresponders (25% to 40%) while on treatment, yet the rate of SVR appears to be by far lower (20%). Better results have been reported with relapsers to prior combination therapy. Moreover, preliminary results from the HALT-C trial have shown that maintenance therapy with pegylated interferon and ribavirin can significantly delay fibrosis progression and reduce the risk of hepatic decompensation and hepatocellular carcinoma and the need of liver transplantation. According to these results, many authors have proposed a course of combination therapy with pegylated interferon and ribavirin for relapsers and nonresponders with advanced fibrosis and cirrhosis.