TREATMENT OF CHRONIC HEPATITIS-C

The antiviral and immunomodulating properties of alpha interferon have led to its current use for the treatment of hepatitis C. Though there is no established treatment duration, a 6-month regimen is usually prescribed. Taking serum transaminase elevation as the outcome criteria, most clinical trials have reported that 50% of the patients are non-responders or partial responders. It is also clearly established that relapse (renewed rise in transaminase levels) occurs in one-half of the complete responders. Thus after a 3-year follow-up, complete long-term response is achieved in only 20% of the patients. Alpha interferon is consequently an undeniable progress in the treatment of chronic hepatitis C, yet raises a number of important questions. Besides chosing the most reliable and informative response criteria to evaluate treatment effectiveness, research is being conducted to isolate factors predicting response and to establish an ''ideal'' protocol. The question of who should be treated also still remains to be answered. Alternative combination therapies such as ursodeoxycholic acid or non-steroid antiinflammatory drugs, could also be beneficial. The most promising development are antiviral drugs with a direct and specific action on viral replication and expression. Ribavirine, the only compound available to date, is under study. In the future the clinician will have several treatment protocols to choose from for adapting management to each individual patient. Clinical cure should signify complete elimination of the causative agent both from the serum and hepatic tissue.