Retreatment of patients who do not respond to initial therapy for chronic hepatitis C
Mitchell L. Shiffman, MD
Hepatology Section, Virginia Commonwealth University Medical Center, Richmond, Va.
Correspondence: Mitchell L. Shiffman, MD, Chief, Hepatology Section, Virginia Commonwealth University Medical Center, Box 980341, Richmond, VA 23298; e-mail: email@example.com
Dr. Shiffman reported that he receives grant or research support from the Roche, Schering-Plough, InterMune, Isis, and Ortho Biotech corporations; serves as a consultant to the Roche and Isis corporations; and is on the speakers’ bureaus of the Roche, Schering-Plough, and Ortho Biotech corporations.
Despite improvements in the treatment of chronic hepatitis C virus (HCV) infection, nearly half of all patients do not respond to initial therapy. Retreatment of these patients with pegylated interferon and ribavirin has been successful in only a limited percentage of cases. Factors associated with sustained virologic response (SVR) following retreatment include prior treatment with interferon monotherapy, HCV genotype 2 or 3, a low serum HCV RNA level, and the absence of cirrhosis. Fewer than 6% of nonresponders who were previously treated with interferon and ribavirin and who have cirrhosis, genotype 1, and a high viral load achieve SVR following retreatment with pegylated interferon and ribavirin. No therapy has been shown to yield SVR in patients who do not respond to pegylated interferon and ribavirin. Long-term maintenance therapy with pegylated interferon is currently being evaluated in nonresponders with advanced fibrosis and cirrhosis. Its use should be considered investigational at this time.