Managing chronic hepatitis C in relapsers and non-responders.
Chronic hepatitis C virus (HCV) infection poses a challenge for a growing number of infected patients who exhibit disease complications, including cirrhosis, hepatocellular carcinoma, and liver failure. Treatment with pegylated interferon (peg-IFN) plus ribavirin improves hepatic markers and eradicates the virus in about 50% of patients; however, a significant number of patients do not respond to therapy or relapse following treatment discontinuation. Several viral, hepatic, and patient-related factors influence response to IFN therapy; many of these factors cannot be modified to improve long-term outcomes. Identifying risk factors and measuring viral load early in the treatment can help to predict response to IFN therapy and determine the need to modify or discontinue treatment. Treatment options for complicated cases of chronic HCV infection are limited. Retreatment with peg-IFN has been successful in some patients who exhibit an inadequate response to conventional IFN treatment, particularly those who have relapsed. Consensus IFN, another option in treatment-resistant patients, has demonstrated efficacy in the retreatment of non-responders and relapsers. Although optimal duration of retreatment and benefits and safety of maintenance therapy have not been determined, an extended duration is likely needed. Anti protease inhibitor drugs, the new frontier of HCV treatment, are now searched as the future answer in the treatment of difficult patients. Unfortunately the results are still confined in a preliminary phase. This article reviews risk factors for HCV treatment resistance and discusses assessment and management of difficult-to-treat patients such as non responders or relapsers to previous treatment.
Montalbano
M
M
ISMETT Mediterranean Institute for Transplantation and Advanced Specialized Therapies, UPMC Italy, Palermo, Italy.
Kemmer
N
N
Neff
G W
GW
D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000188:drug therapy; D012008:Recurrence; D012307:Risk Factors
D007372:Interferons