Review article

Diagnosis and treatment of hepatitis C

Adriana Vince ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Snježana Židovec Lepej ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Ivan Kurelac ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Vjeran Čajić ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Vitomir Burek ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Davorka Dušek ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Jelena Budimir ; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska

Abstract

Virological diagnostics of HCV infection is based on standardized serological and molecular assays. Molecular diagnostics of HCV infection includes assays for HCV RNK detection and/or quantification as well as genotyping assays. HCV genotype is an important parameter in the pre-treatment diagnostic workup that determines treatment duration, ribavirin dosage and represents an excellent predictor of treatment success. Detection and/or quantification of HCV RNK in the serum provides direct evidence of active viral replication in patients with chronic hepatitis C and enables determination of virological response during treatment. According to the Croatian Reference Center for Viral Hepatitis, 60 % of patients with chronic hepatitis C in Croatia are infected with genotype 1, 36 % of patients with genotype 3a and only 4 % of patients with genotypes 2 and 4. Standard treatment regimen for chronic hepatitis C over the past seven years is a combination of pegylated interferon alpha (PEG IFN) and ribavirin (guanosine analogue). However, standard treatment regimen based on the combination of PEG IFN and ribavirin for 48 weeks fails to achieve sustained viral response in 50 % of patients with genotype 1. Furthermore, 25 % of patients infected with genotype 3a will fail to respond to a standard 24 week regiment. Up-to date treatment of chronic hepatitis C should be individualized (treatment guided) according to the genotype, liver fibrosis, early viral kinetics and viremia. Modification of treatment algorithm in patients with genotype 1 who are late responders to treatment should include prolonged treatment (72 weeks). In patients infected with genotypes 2 and 3 and low viremia who are rapid responders, therapy can be shortened to 16 weeks. Patients with higher fibrosis rates (fibrotic septa) should not be treated according to viremia because in those patients viremia does not correlate with the ability to achieve sustained viral response. Meta-analysis of recent clinical trials on the treatment of acute hepatitis C showed that monotherapy with PEG IFN for 24 weeks is the suggested treatment regimen for this group of patients.

Keywords

hepatitis C; treatment; pegylated interferon; ribavirin; rapid virological response; viral kinetics

Hrčak ID:

43783

URI

https://hrcak.srce.hr/43783

Publication date:

16.6.2009.

Article data in other languages: croatian

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