Causes and management of chronic hepatitis C in treatment experienced patients
Chronic Hepatitis C is a major public health issue, affecting >2% of the worlds population. Combination treatment with pegylated interferon alfa and ribavirin is successful in achieving long-term viral suppression in about 50% of patients. The ever-growing population of relapsers and non-responders to PEG-IFN + ribavirin poses a difficult clinical problem. We investigate the causes of treatment failure, whether virus-related (HCV genotype, quasispecies diversity and viral load) or host-related (age, sex, race, fibrosis/cirrhosis, obesity and insulin resistance) and review the results of recently published trials on the treatment of relapsers and non-responders to PEG-IFN + ribavirin, focusing on the prognostic value of week 12 HCV-RNA measurements.