Into the light: strategies for battling hepatitis C

The primary measurable goal of hepatitis C virus (HCV) therapy is permanent eradication of the virus (ie, a sustained virologic response [SVR]). Treatment decisions depend on the severity and treat ability of the infection, contraindications to treatment, and patient preferences. The current standard of treatment is combination therapy with pegylated interferon (peginterferon) and ribavirin. Dosages and treatment duration vary according to viral genotype. About 70% to 80% of patients with genotype 2 or 3 will achieve SVR compared with only 40% to 50% of patients with genotype 1. Generally, those who previously failed HCV treatment with monotherapy or standard interferon plus ribavirin should be considered for re-treatment with a trial of peginterferon and ribavirin. Side effects associated with treatment include influenzalike symptoms, insomnia, neutropenia, and hemolytic anemia and should be managed aggressively to promote patient adherence to therapy. Future pharmacologic agents are currently in development for patients failing treatment or those who have relapsed.