[HCV non-responder patients: definition of non-response and treatment strategy].
About half of patients with chronic hepatitis C do not respond to the current treatment combining pegylated interferon and ribavirin. One must distinguish the "false" non responders who did not receive an optimal treatment and the "true" non responders who received an optimal treatment. In "false" non responders, the management of the factors of non response (alcohol consumption, body overweight...) or the improvement of tolerability to therapy (anti-depressive therapy, erythropoietin...) may allow an optimized retreatment with a chance of viral eradication. On the opposite, in "true" non responders, the probability to obtain with retreatment a viral eradication is very low and one must envisage, in case of severe liver disease (fibrosis stage F3 or F4), maintenance therapy. The objective of maintenance therapy is to decrease the activity of the chronic hepatitis and stabilize fibrosis in order to decrease the risk of complications and hepatocellular carcinoma. The ongoing trials will determine the optimal schedule of maintenance therapy. The new antivirals, mainly protease inhibitors and polymerase inhibitors, will probably be used in triple therapy with pegylated interferon and ribavirin. The drugs, currently in phase 1 and 2, which will demonstrate their efficacy and safety, should not be available before several years.
Marcellin
Patrick
P
Service d'Hépatologie, INSERM U773 CRB3, Université Paris VII, Hôpital Beaujon, Clichy, France. patrick.marcellin@bjn.aphp.fr
Bourlière
Marc
M
Pawlotsky
Jean-Michel
JM
Ouzan
Denis
D
D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000517:prevention & control; D019233:Retreatment
D000998:Antiviral Agents