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Arch Hellen Med, 20(6), November-December 2003, 617-624


Therapy of chronic hepatitis C in patients with relapse

Academic Department of Medicine, Hippokration General Hospital, Athens, Greece

Interferon-α (IFN-α) in a dose of 3 MU, thrice weekly, for 12 months, has a limited (around 20%) sustained virologic response in naive patients with chronic hepatitis C. This review discusses therapy options for patients with hepatitis C virus who relapse after an initial virologic response to treatment. In patients who have relapsed after IFN-α monotherapy two options can be considered: To treat with a combination of IFN-α 3 MU thrice weekly and ribavirin 1000–1200 mg daily for 6 months providing there are no contraindications to ribavirin, or to treat with a high dose (more than 3 MU or 9 μg, thrice weekly) of IFN-α for 12 months. In both options, HCV-RNA should be checked after 3 months and therapy should be discontinued if HCV-RNA remains positive. This retreatment gives a 50% general sustained viral response. Histologic improvement occurs in nearly two thirds of patients retreated with combination therapy and is most pronounced in those who lose serum HCV-RNA. The viral genotype and HCV-RNA levels influence the rate of response to retreatment. The sustained viral response in genotype 1 patients is 29% using combination therapy for 6 months and is thought to be better with longer therapy. The presence of fibrosis or cirrhosis does not appear to decrease the response to combination therapy. Six to 9% of patients discontinue combination therapy because of an adverse event. In conclusion, IFN-α is used in combination with ribavirin or alone in high doses in patients who relapse after initial treatment with IFN-α. For patients who relapse after combination therapy, high dose IFN-α or a combination of pegylated IFN-α and ribavirin, with or without induction therapy, can possibly offer a sustained virologic response.

Key words: Chronic hepatitis C, Interferon-α, Pegylated interferon-α, Ribavirin.

© Archives of Hellenic Medicine