Approach to the management of patients with chronic hepatitis C who failed to achieve sustained virologic response.

The combination of PEGIFN and RBV is the most effective therapy for patients with chronic hepatitis C. Although more than half of all patients are able to achieve SVR, a significant proportion of patients, particularly those with genotype 1, fail to have undetectable HCV RNA during treatment or relapse after completing therapy with return of detectable HCV RNA. An approach in the management of these patients is to identify factors that could have led to the NR or relapse and that could be corrected before or during a second course of therapy. Because fibrosis progression occurs slowly over decades for many patients with chronic hepatitis C, avoiding alcohol or other factors that could lead to fibrosis progression may be sufficient for the vast majority of patients. Other options that could be considered in patients who have more advanced disease include retreating with one of several new antiviral agents; retreating with higher doses of IFN or PEGIFN and RBV; or using IFN, PEGIFN, or RBV monotherapy long-term as maintenance therapy. The safety and efficacy of these approaches is being evaluated in numerous clinical trials.