[Therapy concepts in chronic hepatitis C]

Patients with persistently normal transaminases and without inflammatory changes or fibrosis in liver biopsy have a low risk for progression, respond poorly to antiviral therapy and should thus not be treated for the present. Patients with significant histologic activity or advanced stage of fibrosis are at risk for progression towards cirrhosis. The risk is significantly increased with chronic alcohol consumption even in moderate doses. Treatment with interferon alone results in sustained virological remission in less than 20% of these patients. Treatment success, however, is 2 to 6 times higher under combined treatment with interferon plus ribavirin. The response rate may be further increased with high-dose and daily interferon administration (inductive dosing). The best treatment option for patients with chronic hepatitis C, therefore, is their inclusion in one of the study protocols (examining combinations and induction) currently active in Switzerland.