[Optimal antiviral therapy of chronic hepatitis caused by hepatitis C virus]

Abstract

Chronic HCV disease is a major health problem world-wide. The majority of HCV positive patients will develop progressive liver disease with a high risk for cirrhosis and hepatocellular carcinoma after 20 and 30 years respectively. Sustained response after a 6, month course of interferon therapy is about 30%. New insights in viral biology and virus-host interactions led to new guidelines for diagnosis and therapy. Seventy percent of anti-HCV positive persons with persistently normal ALAT levels are HCV-RNA positive, and 60-70% of these have chronic hepatitis histologically. Biochemical parameters alone are inadequate for diagnosis of the disease and evaluation of therapy. HCV-RNA positive patients with normal serum ALAT and chronic hepatitis histologically should be considered for antiviral therapy within the setting of clinical trials. Response rates to interferon have been doubled with 1 year treatment. Additional improvement may be achieved by higher dosage, especially in patients with hepatitis caused by genotype 1b viruses. Including viral and host parameters in therapeutic strategy may lead to selective adaptation of dosage in order to optimize interferon therapy and to further improve its cost-effectiveness.