Treatment of chronic hepatitis C: practical aspects

The initial enthusiasm about the potential of alpha-interferon therapy for chronic hepatitis C might be weaning in view of the low virus clearance rate of about 15%. At the same time, the potential of interferon to induce sustained remission of the disease is rapidly growing by 3 modalities: a) prolongation of therapy from 6 to 12 months in order to reduce relapse; b) combination of interferon with ribavirin to reduce early non-response, breakthrough and relapse; c) high dose induction therapy; Benefit-risks/cost ratios vary for the different stages of chronic hepatitis C. Consensus exists on the indication of therapy for chronic hepatitis with fibrosis, whereas benefits in very early and very late stages of chronic hepatitis C are doubtful; patients with cirrhosis are clearly in need of therapy but remission is less than 10% and such patients are encouraged to participate in controlled trials assessing combination and/or newer therapy modalities. For decompensated cirrhosis, liver transplantation is the treatment option of choice.