[Treatment of hepatitis C virus infection].
Undetectable hepatitis C virus (HCV)-specific RNA in serum six months after the end of treatment is the primary aim of antiviral therapy in patients with chronic hepatitis C. Long-term studies confirmed that viral eradication is durable in more than 95% of cases. The high chronification rate of acute hepatitis C (50 to 80%) justifies therapeutic strategies to prevent a chronic course of the infection. Monotherapy with interferon-alpha for 24 weeks can prevent chronification in more than 90% of patients with acute hepatitis C. Antiviral therapy should be considered in all patients with chronic hepatitis C, who are symptomatic, or have a considerable risk for the development of liver cirrhosis and its sequelae, if they have no contraindication for therapy. Furthermore, treatment should be considered in all patients who carry a substantial risk to infect others. Combination therapy with a pegylated interferon-alpha plus ribavirin is the current standard of care and achieves sustained virologic response rates of 54 to 61%. Patients chronically infected with genotype HCV-1 isolates should be treated for 48 weeks (independent from baseline viral load), while in patients infected with HCV-2 or -3 isolates 24 weeks of treatment are sufficient. Patients without sustained virologic response can still benefit histologically from an interferon-alpha based therapy. Possibly, interferon-alpha also reduces the risk for patients with chronic hepatitis C to develop hepatocellular carcinoma.
Zeuzem
S
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Klinik für Innere Medizin II mit den Schwerpunkten Gastroenterologie, Hepatologie und Endokrinologie, Universitätsklinikum des Saarlandes, Homburg, Saar. Zeuzem@uniklinik-saarland.de
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000208:Acute Disease; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D008137:Longitudinal Studies; D015201:Meta-Analysis as Topic; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins; D012008:Recurrence; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a