Treatment of hepatitis C in 2011: what can we expect?

Treatment for chronic hepatitis C virus (HCV) infection is the combination of a peginterferon and ribavirin. Although a fixed duration of treatment (24 weeks for patients with genotypes 2 and 3 and 48 weeks for patients with all other genotypes) has been advocated, the best results are likely to be achieved when the duration of therapy is adjusted based on the time to response. According to the principles of response-guided therapy, patients with rapid virologic response have a high rate of sustained virologic response (SVR) and a low rate of relapse, and can be treated for 24 weeks regardless of genotype. In contrast, patients who become HCV RNA undetectable at a slower rate need a longer duration of therapy. Direct-acting antiviral agents are currently being developed to treat patients with HCV genotype 1. These agents will significantly increase rapid virologic response when used with peginterferon and ribavirin; according to the concepts of response-guided therapy, such treatment will yield high rates of SVR with 24 to 28 weeks of treatment.