Current and future therapies of hepatitis C.
With recent advances in the treatment of chronic hepatitis C, patients with elevated aminotransferase levels, detectable HCV RNA in the serum, and chronic inflammation are candidates for therapy. The best initial therapy is interferon plus ribavirin, achieving a sustained response rate in 40% of patients. The duration of therapy should be based on HCV genotype (48 weeks for genotype 1; 24 weeks for other genotypes). Serum HCV RNA should be measured at week 24 to assess response and guide further therapy in patients with genotype 1 infection. Patients unsuitable for combination therapy can be treated with interferon monotherapy. Side effects, dose modification and discontinuation are generally more frequent with interferon plus ribavirin, but can be managed with close follow-up and careful monitoring. With rapid developments in treatment, new therapies will require careful prospective evaluation according to HCV genotype and viral-load characteristics. Recommendations for therapy will probably change every few years, and novel approaches may provide effective therapy for most patients with hepatitis C.
Shad
J A
JA
Division of Gastroenterology and Hepatology, Scripps Clinic and Research Foundation, La Jolla, California, USA.
McHutchison
J G
JG
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D000998:Antiviral Agents; D002219:Carbamates; D004791:Enzyme Inhibitors; D065089:Glycoside Hydrolase Inhibitors; D007155:Immunologic Factors; D016898:Interferon-alpha; C407002:N-3-(3-(3-methoxy-4-oxazol-5-ylphenyl)ureido)benzylcarbamic acid tetrahydrofuran-3-yl ester; D010671:Phenylurea Compounds; D012367:RNA, Viral; D012254:Ribavirin; D007168:IMP Dehydrogenase