Treatment of chronic hepatitis c.
Since the discovering of the hepatitis C virus in 1989, the treatment of hepatitis C has considerably improved. Initially, with interferon alpha used as a single drug, the sustained virological response rate was below 20%. Then, with the use of combination therapy of interferon a with ribavirin, the response rate increased to 41%. More recently, combination of pegylated interferons with ribavirin give a response rate of about 54-63%. The long-term follow-up studies showed that sustained virological response is generally associated with clinical and histological improvement. The indication of therapy is mainly based on the results of the liver biopsy which is the best way to assess the prognosis of the liver disease. Therefore, treatment is indicated in patients with moderate or severe necroinflammation or fibrosis. The tolerability of combination therapy is relatively poor with a frequent flu-like syndrome and an impaired quality of life. Factors associated with a poor response to treatment are essentially genotype 1 and high viral load. To further improve the efficacy of therapy, different new drugs are under investigation (amantadine, cytokines). These drugs may be candidates for new combinations. In addition, intensive research is currently done for the development of inhibitors of viral enzymes (helicase, protease or polymerase) and anti-sense oligonucleotides, ribozymes and therapeutic vaccine.
Marcellin
P
P
Unit of Hepatology, Claude Bernard Research Center on Viral Hepatitis, INSERM U-481, Hospital Beaujon, Clichy, France. marcellin@bichat.inserm.fr
Asselah
T
T
Ripault
M P
MP
Boyer
N
N
D019698:Hepatitis C, Chronic / Q000628:therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use
D016898:Interferon-alpha; D012254:Ribavirin