PEG-interferon in acute and chronic hepatitis C: a review

Abstract

In patients affected by chronic hepatitis, prevention of hepatitis C virus (HCV) infection complications can be achieved by antiviral therapy based on the use of a combination of pegylated interferon (PEG-IFN) alfa-2b and ribavirin, which yields a sustained eradication of infection in 40% to 50% of cases. The aim of this review is to evaluate the efficacy of PEG-IFN alpha in the treatment of acute and chronic HCV-related hepatitis. In patients affected by acute hepatitis C, the treatment is represented by PEG-IFN alpha-2b monotherapy, and combination therapy with ribavirin produces a similar response to that with interferon monotherapy. Treatment must be started within 3 months of onset of infection (at the first evidence of HCV RNA positivity) and must be prolonged for 3 months for patients affected by genotypes 2 and 3 and for 6 months for patients with genotype 1 or 4. For patients affected by chronic hepatitis C, the first line of therapy is the combination PEG-IFN alpha-2a or alpha-2b and ribavirin. Treatment must be started only for patients with detectable serum HCV RNA and an alanine aminotransferase (ALT) value >80 IU/L (normal value, 40 UI/L); if serum HCV RNA is detectable but the ALT value is normal or <80 IU/L, the patient must be monitored every 6 months. In patients infected by genotypes 1 or 4, before treatment a histological evaluation is needed only for those aged >50 years. These patients can be treated if the infection stage is >/=2 according to the Knodell index. In patients aged <50 years, in my opinion, histological evaluation is not needed, because treatment must be started also for patients with stage 1 infection. The treatment must be prolonged for 1 year, but if after 3 months of therapy the patient is positive for serum HCV RNA, then therapy must be stopped and the patient is considered a nonresponder. In patients affected by genotypes 2 and 3, therapy must be prolonged for 6 months and a histological evaluation before treatment is not needed.