2003 Treatment of chronic hepatitis C in Europe.


J Hepatobiliary Pancreat Surg. 2003;10(2):168-71.
Treatment of chronic hepatitis C in Europe.

Colombo M, Rumi MG, Ninno ED.

Division of Hepatology, IRCCS Maggiore Hospital, Department of
Medicine,
University of Milan, Via Pace 9, 20122 Milan, Italy.

The lifetime cumulative risk of developing cirrhosis and hepatocellular
carcinoma is the rationale for treating patients with chronic hepatitis
C
with antivirals. The standard treatment is combination therapy with
interferon-alfa and ribavirin. In patients with high transaminases and
histologic signs of chronic hepatitis, 6- to 12-month therapy with 3
mega
units (MU) interferon-alfa thrice weekly, combined with ribavirin,
yielded
up to 30% sustained responders, and this was increased to 50% with
pegylated interferon combined with ribavirin.

Favorable predictors of response to the former treatment were genotype
2 or
3, less than 2 million copies of hepatitis C virus (HCV), no portal
fibrosis at biopsy, age less than 40 years, and female sex. The same
was
true for the latter treatment; however, with body weight less than 82
kg
replacing female sex.

A 98% cure of community-acquired acute hepatitis C was achieved with
early
treatment with daily doses of 5 MU interferon, compared with a
calculated
30% HCV-RNA clearance in untreated patients. More cost-effective
strategies
for ceasing treatment, based upon early clearance of HCV, are under
investigation, with cutoff equal to or more than a 2 log decrease in
serum
HCV-RNA at week 12. This approach has 100% negative predictive value
and
80% positive predictive value.

Treatment can also be optimized by combination retreatment of relapsers
and
nonresponders to monotherapy, which yielded sustained responses of 50%
and
25%, respectively. There are difficult-to-treat patients who have high
viremia, genotype 1 and 4, or coinfection with HIV or HBV, or carry an
organ graft, and those who did not respond to combination therapy.
Extended
treatment of the latter patients with pegylated interferon might slow
down
the progression of fibrosis.

PMID: 14505151 [PubMed - indexed for MEDLINE]

Source URL:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=14505151






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