PROPHYLAXIS AND TREATMENT OF HEPATITIS-C

Interferon is the only treatment shown to be effective on hepatitis C in controlled trials. The response to treatment is generally assessed in terms of a return to normal transaminase activity, but also negativ e PCR testing for viral RNA and histopathological examination of the l iver. At a dose of 3 MU three times a week for 6 months, 25 % of patie nts have a persistent return to normal transaminase activity, 25 % rel apse when interferon is withdrawn, and the remaining 50 % have persist ently high levels at the and of treatment and are considered resistant . The rate of persistent responses increases to 40 % when treatment is extended to one year. Viral RNA becomes undetectable in the serum of 80 % of these responders. Most also have a histological improvement, b ut so do a number of patients who relapse or who are resistant. In the longer term, interferon could prevent the onset of liver cancer in pa tients with viral C cirrhosis. Interferon is generally well tolerated at the doses currently used, most side effects (hematologic, neuropsyc hiatric and thyroid disorders) resolving when treatment is continued. The following factors are clearly predictive of the response to interf eron: young age, short time since onset. absence of cirrhosis, lower-l evel viremia, and infection by HCV genotypes other than Ib. Interferon is markedly less effective in immunodeficient patients (transplant, H IV infection, etc,). Several add-on treatments have been tried, but ri bavirin appears to be the most promising, both during initial interfer on therapy and for patients who relapse or are resistant to a first co urse. Interferon therapy of the acute phase of hepatitis C significant ly reduces the risk of chronic liver disease. There is no vaccine agai nst HCV infection.