Management of untreated and nonresponder patients with chronic hepatitis C.
Hepatitis C infection has evolved in the past quarter century from a newly recognized entity without a known pathogen (non-A, non-B hepatitis) to one of the world's most prevalent causes of liver disease, an important source for hepatocellular carcinoma, and the major indication for liver transplantation. It is caused by a virus with a complex replication cycle that occurs in multiple genotypes, of which the four most prevalent (1, 2, 3, and 4) exhibit differences in clinical behavior and responses to therapy. Chronic hepatitis C virus (HCV) in particular has evolved from a disease with no known treatment to one with several primary treatment options, none of which is uniformly effective, and a growing list of secondary treatment options for those who have failed to respond to, or relapsed after initial therapy. As treatment is often associated with significant side effects, it is now a disease that presents clinicians with multiple important decisions: whom to treat, when and with what to treat them initially, and how to manage patients who have failed during initial therapy to achieve a sustained virological response, the gold standard of effective therapy. This review examines each of these important decisions, presenting evidence to help guide clinicians in their choices. The decisions are addressed sequentially as they arise during the initial evaluation and subsequent treatment of a typical, newly recognized patient with chronic HCV, and the considerations facing the clinician when the patient has failed to achieve an SVR.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA. Mahler68@hotmail.com
Leonard B
LB
Seeff
Marc G
MG
Ghany
D000428:Alcohol Drinking; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D003657:Decision Making; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019468:Disease Management; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000008:administration & dosage; D010818:Practice Patterns, Physicians'; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins; D019233:Retreatment; D012254:Ribavirin / Q000008:administration & dosage; D017211:Treatment Failure; D019562:Viral Load; D014779:Virus Replication / Q000502:physiology
C552098:2'-fluoro-2'-methyl-3',5'-diisobutyryldeoxycytidine; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D003841:Deoxycytidine; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a