[Treatment optimization in chronic hepatitis C virus infection].
The treatment duration that obtains the optimal risk-benefit ratio in chronic hepatitis C infection is guided by viral kinetic data in weeks 4 and 12. Rapid virological response (RVR) and early virological response (EVR) have high positive and negative predictive value, respectively. Patients with genotype-1, RVR, without significant fibrosis and low baseline viral load (<600,000UI/ml) can receive treatment for 24 weeks without loss of efficacy, while the absence of EVR in these patients is a criterion for treatment interruption. Data on prolonging treatment to 72 weeks in patients with genotype 1 and a decrease of >2log in viremia without negativization of viremia in week 12 are contractictory. In patients with genotypes 2 and 3, 24-week treatment is superior to 16-week treatment, although 16-week treatment can be evaluated in patients with genotype 3 and RVR. In patients with genotype 2 and RVR, rates of RVR in 14-week treatment are similar to those in 24-week treatment, while in patients without RVR, treatment should be continued to 24 weeks. Key factors in treatment optimization are the weight-adjusted dose of ribavirin and therapeutic adherence.
Fernández Rodríguez
Conrado M
CM
Servicio de Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. cfernandez@fhalcorcon.es
Alonso López
Sonia
S
D000328:Adult; D000465:Algorithms; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b