[Treatment of naive patients with chronic hepatitis C].

According to published data, 60% of hepatitis C virus (HCV)-infected patients in Croatia have HCV genotype 1. The second most common genotype is 3a (36%). Standard treatment regimen for patients with chronic hepatitis C is a combination of pegylated interferon alfa (2a or 2b) with ribavirin, in duration guided by genotype: patients with genotype 1 are treated for 48 weeks and patients with genotypes 2 and 3 for 24 weeks in order to achieve virus elimination defined as HCV RNA undetectability 24 weeks after the treatment period (SVR). These treatment regimens fail to achieve SVR in 50% of patients with genotype 1 and 25% of patients with genotype 3. On the other hand, patients with low viral load (<600 000 IU HCV RNA/mL) and rapid viral response (RVR) could benefit from shortened treatment. Recent studies and meta-analyses have shown the importance of liver fibrosis, viral kinetics and viremia as predictors of SVR. Currently, treatment of chronic hepatitis C should be individualized (treatment guided) according to the genotype, liver fibrosis, early viral kinetics and viremia. In patients with genotype 1 who are late responders (pEVR), therapy should be prolonged to 72 weeks in order to achieve 12% better SVR. In patients with genotype 2,3 with low viremia who are rapid responders (RVR+), therapy can be shortened to 16 weeks. Patients with higher fibrosis rates (presence of fibrotic septa) should not be treated according to the level of viremia, as it has been shown that viremia does not correlate with SVR in these patients. Liver biopsy is still recommended in the pretreatment evaluation protocol for its prognostic features. In patients with acute hepatitis C, treatment should be started if HCV RNA is still present at week 12. The suggested treatment regimen is monotherapy with pegylated interferon alfa (2a or 2b) for 24 weeks.