MANAGEMENT OF HEPATITIS-C

Chronic hepatitis C is a major health care problem throughout the worl d. The disease may progress to cirrhosis, with complications such as h epatocellular carcinoma, The usual primary goal of therapy is viral er adication, as patients with long-term remission are generally regarded as unlikely to develop cirrhosis or hepatocellular carcinoma. Another primary goal should be the reduction in liver fibrosis progression, I nterferon-alpha (IFN-alpha) is the only drug approved for the treatmen t of hepatitis C in Europe and North America. Its effectiveness appear s to be related to dose and duration of therapy, The best efficacy/ris k ratio seems to be in favour of 3 million units (MU) IFN-alpha three times per week on a 12-month schedule. With this regimen, a sustained alanine aminotransferase (ALT) response is achieved in nearly 35% of p atients. Ribavirin has emerged as potentially the second most effectiv e drug. While it appears unsatisfactory when given alone, it seems muc h more effective in combination with IFN. Combining them seems to exer t a synergistic effect between the two drugs and sustained remission m ight be achieved in nearly 50% of patients with combination therapy. C ontroversy persists concerning the long-term benefit of therapy in tra nsient responders and non-responders, It is possible that IFN therapy, in comparison to natural history, might reduce liver fibrosis progres sion and prevent hepatocellular carcinoma, even in non-responders, and have greater efficacy if used in long-term treatment, Whatever the tr eatment schedule, prolonged viral eradication may not be achieved in a ll patients and new drugs should be sought to improve the results of t herapy.