| Summary: | Chronic hepatitis
C (CHC) is a major health problem worldwide, with approximately
200 million affected individuals and a significant rate of
progression to end-stage cirrhosis and hepatocellular carcinoma
(HCC). If hepatitis C virus (HCV) infection is left untreated in
the population, then the number of liver-related deaths will soon
double and the need for liver transplantation may increase to five
times that seen today. Available therapies for CHC are restricted
to interferon alpha (IFN-α ) monotherapy and to the combination
of IFN-α and ribavirin. Despite their high cost and side effects,
both of these therapies have proved to be cost effective, particularly
combination therapy. IFN-α monotherapy for one year can
induce sustained response (SR) rates of approximately 10% in naive
patients infected with HCV genotype 1, and above 50% in
those infected with other genotypes. Combination therapy can
double or even triple the rate of SR in genotype 1 infections and
may further increase the SR rate in the other HCV genotypes.
Combination therapy has also been proven to be effective in approximately
50% of relapsed responders to IFN-α monotherapy. In
clinical practice, the decision to treat should be individualized and
tailored on the basis of several virus- and host-related factors, particularly
the grade and stage of liver disease, HCV genotype and
levels of viremia. Appropriate monitoring of therapy by careful
clinical evaluation, liver biochemistry and serumHCVRNAtesting
is mandatory. IFN-α therapy may also prove to be effective in
reducing the rate of HCC development in CHC regardless of
whether a virological response is achieved, but this remains to be
established.
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