Treatment options for chronic hepatitis C

Patients with persistently normal transaminases and without inflammatory ch anges or fibrosis in liver biopsy have a low risk for progression, respond poorly to antiviral therapy and should thus not be treated for the present. Patients with significant histologic activity or advanced stage of fibrosi s are at risk for progression towards cirrhosis. The risk is significantly increased with chronic alcohol consumption even in moderate doses. Treatmen t with interferon alone results in sustained virological remission in less than 20% of these patients. Treatment success, however, is 2 to 6 times hig her under combined treatment with interferon plus ribavirin. The response r ate may be further increased with high-dose and daily interferon administra tion (inductive dosing). The best treatment option for patients with chroni c hepatitis C, therefore, is their inclusion in one of the study protocols (examining combinations and induction) currently active in Switzerland.