Therapy for chronic Hepatitis B and C: problem patients

Indication criteria as well as therapeutic end-points have been established with increasing reliability for chronic Hepatitis B and C in recent years, and treatment concepts have been determined by clinical trials. In addition, alternative therapies have been tested in order to provide therapeutic options to the large patient-group of non-responders. The indications for therapy remain, in most of these problematic cases, a matter of reconsidering acute treatment in relation to the realistic beneficial outcome. Patients with a coincidental influencing factor [coinfection, im-munosuppression, mutant-infection (HBV) or "bad" genotype (HCV) on underlying liver cirrhosis, etc.] build additional special groups. Therapy indications for these groups have to be defined according to the degree of risk of progression and decompensation of the liver disease.