Treatment of Chronic Hepatitis C Virus Infection

Hepatitis C virus (HCV) is the major causative agent ofnon-A and non-B hepatitis.1 The disease is widespread, with a worldwide prevalence estimated at 100 million indi-viduals.2 Approximately 20–30 % of patients with chronic HCV infection progress to end-stage liver disease requir-ing liver transplantation or die from complications of cir-rhosis. HCV infection is the most common indication for liver transplantation in the US.3 Chronic liver disease is the second leading cause of death in patients who undergo kid-ney transplantation, and a large proportion of this is due to HCV infection.4 Thus, chronic HCV infection is a serious public health problem. Although few data are available regarding the long-term benefits of treatment of HCV infection, short- and interme-diate-term evidence supporting aggressive treatment is ac-cumulating. In the decade following the discovery of HCV, biotechnology has provided physicians a wide variety of tools enabling diagnosis and determination of prognostic factors. These include an enzyme-linked immunosorbent assay, a recombinant immunoblot assay for the detection of HCV antibodies, and serotyping for determination of the HCV genotype. In addition, HCV-RNA is detected based on the polymerase chain reaction, as well as meth-ods for determination of viral load. A description of these tests is beyond the scope of this article, but have been well summarized elsewhere.5 In this article, we review the cur-rent regimens used in the treatment of chronic HCV infec-tion. Interferon Monotherapy Prior to the identification of HCV in 1989, the use of in-terferon was studied in patients with non-A and non-B hepatitis. The majority of these patients were subsequently shown by serologic testing to have HCV infection. The first study6 was conducted at the National Institutes of Health (NIH) in 1986. The initial encouraging results of this study prompted several randomized, controlled trials. In a meta-analysis of 18 randomized, controlled trials,7 treatmen