Antiviral therapy of hepatitis C

Chronic hepatitis C can be treated with interferon therapy, but persistent viral clearance is only achieved in 20% of patients. Which patients have a high chance of viral clearance and what other treatment might enhance the effectivity of interferon therapy are reviewed.

Data from published randomized trials on interferon mono-therapy, ribavirin mono-therapy and combination therapy of interferon-ribavirin and interferon-ursodeoxycholic acid are analysed separately and in a meta-analysis of individual data.

Interferon mono-therapy leads to viral clearance in only 10% of patients with genotype 1 and in less than 10% in cirrhosis; patients with plasma HCV RNA detectable at 4 weeks of therapy have only 2% chance of viral clearance. Prolongation of therapy reduces relapse in treatment responders. Interferon-ribavirin combination therapy appears to enhance the efficacy 2-3 fold without increasing toxicity.

The benefit-risk/cost ratio of interferon mono-therapy can be improved by selection of patients, monitoring plasma HCV RNA at 4 weeks, and prolonging therapy to 12 months in responders with genotype 1. Interferon-ribavirin combination is promising for its enhanced efficacy.