Chronic hepatitis C and no response to antiviral therapy:A perpetual problem

Abstract

SUMMARY
No-response to antiviral therapy was observed in the majority
of chronic hepatitis C patients treated with interferon
alpha (IFN-a) monotherapy, but continues to represent
a frequent problem even after treatment with newer, more
potent, combination regimens. Non-responding patients
represent a fairly heterogeneous group. Subgroups of nonresponders
with biochemical but without virological response,
or with breakthrough phenomena during therapy
probably have a relatively more favorable prognosis. Retreatment
with consensus IFN may be relatively effective,
while the combination of IFN-a in usual dosage and ribavirin
(RIB) achieves sustained virological response in 13%
and 21% of such patients treated for 6 and 12 months, respectively.
Induction courses of IFN-a in combination with
RIB have been found to achieve initial virological response
in 36-40% and sustained virological response in 17-26%.
Triple antiviral therapy with IFN-a, RIB and amantadine
has also been used, but more trials are needed for firm conclusions.
Recently, the combination of pegylated IFN-a plus
ribavirin was reported to achieve initial virological response
in 36-40% of patients non-responding to IFN-a monotherapy
or to a combination of IFN-a plus ribavirin. Extensive
data suggest that therapy with IFN-a may delay the progression
of fibrosis and decrease the incidence of hepatocellular
carcinoma even in non-responding chronic hepatitis
C patients. Thus, the decision whether or not to discon-tinue the antiviral therapy in non-responders is related to
whether therapy aims the clearance of the virus or just a
histological benefit.
Key words: Chronic hepatitis C, no-response, Interferon,
Ribavirin, Amantadine, Induction therapy