Treatment optimization in chronic hepatitis C virus infection

The treatment duration that obtains the optimal risk-benefit ratio in chronic hepatitis C infection is guided by viral kinetic data in weeks 4 and 12. Rapid virological response (RVR) and early virological response (EVR) have high positive and negative predictive value, respectively. Patients with genotype-1, RVR, without significant fibrosis and low baseline viral toad (<600,000 Ul/ml) can receive treatment for 24 weeks without loss of efficacy, white the absence of EVR in these patients is a criterion for treatment interruption. Data on prolonging treatment to 72 weeks in patients with genotype 1 and a decrease of >2 log in viremia without negativization of viremia in week 12 are contractictory. In patients with genotypes 2 and 3, 24-week treatment is superior to 16-week treatment, although 16-week treatment can be evaluated in patients with genotype 3 and RVR. In patients with genotype 2 and RVR, rates of RVR in 14-week treatment are similar to those in 24-week treatment, while in patients without RVR, treatment should be continued to 24 weeks. Key factors in treatment optimization are the weight-adjusted dose of ribavirin and therapeutic adherence. (C) 2009 Elsevier Espana, S.L. All rights reserved.