[Treatment response in chronic hepatitis C. Content of virus in serum is decisive for the outcome]

The article consists in a brief review of pre-treatment evaluation and antiviral treatment of chronic hepatitis C (HCV) infection. Patients with viraemia (i.e. HCV RNA seropositive with the PCR technique) should be evaluated historically if they lack contraindications for interferon alpha (IFN-alpha) treatment. Patients with depression, autoimmune and thyroid disorders, decompensated cirrhosis, or solid organ transplants, are ineligible for-IFN-alpha treatment. If the histological evaluation shows moderate to severe chronic hepatitis, and the HCV RNA level is < 3 million Eq/mL serum as measured by bDNA, naive (i.e. formerly untreated) patients should be given an initial 12-week course of IFN-alpha to evaluate treatment response. Those who become HCV-negative should continue the treatment for 48 weeks to increase the likelihood of sustained virological response after treatment cessation. Treatment should be discontinued in the case of patients still HCV-positive at 12 weeks, as the chances of obtaining sustained response are remote. Patients with higher pre-treatment HCV RNA levels (> or = 3 million Eq/mL) and patients manifesting unsustained response to earlier IFN treatment should receive combination treatment with ribavirin and IFN-alpha, as treatment with IFN alone is associated with poor chances of sustained response. This treatment approach is associated with an estimated sustained response rate in naive patients of 40-50 per cent.