Retreatment of patients who do not respond to initial therapy for chronic hepatitis C.
Despite improvements in the treatment of chronic hepatitis C virus (HCV) infection, nearly half of all patients do not respond to initial therapy. Retreatment of these patients with pegylated interferon and ribavirin has been successful in only a limited percentage of cases. Factors associated with sustained virologic response (SVR) following retreatment include prior treatment with interferon monotherapy, HCV genotype 2 or 3, a low serum HCV RNA level, and the absence of cirrhosis. Fewer than 6% of nonresponders who were previously treated with interferon and ribavirin and who have cirrhosis, genotype 1, and a high viral load achieve SVR following retreatment with pegylated interferon and ribavirin. No therapy has been shown to yield SVR in patients who do not respond to pegylated interferon and ribavirin. Long-term maintenance therapy with pegylated interferon is currently being evaluated in nonresponders with advanced fibrosis and cirrhosis. Its use should be considered investigational at this time.
Shiffman
Mitchell L
ML
Hepatology Section, Virginia Commonwealth University Medical Center, Box 980341, Richmond, VA 23298, USA. mlshiffm@vcu.edu
D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D001741:Black or African American; D000437:Alcoholism / Q000150:complications / Q000628:therapy; D000547:Amantadine / Q000008:administration & dosage / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003376:Counseling; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007372:Interferons / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications; D015201:Meta-Analysis as Topic; D016376:Oligonucleotides, Antisense / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077596:Thymalfasin; D013947:Thymosin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013997:Time Factors; D044465:White People
D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; D016376:Oligonucleotides, Antisense; D012367:RNA, Viral; D012254:Ribavirin; D013947:Thymosin; D007372:Interferons; D000547:Amantadine; D000077596:Thymalfasin