Alternative treatments for patients with chronic C hepatitis who did not respond previous treatments

Treatment of chronic hepatitis C (HCV) has improved during the last decade with peg Interferon ribavirin (peg IFN-riba) increasing sustained viral response from 6 to 60%. Even though, there is an increasing number of non responding patients that constitutes up to 50% of HCV in referral centers nowdays. This is an heterogenous group for diverse reasons (failure of response to monotherapies, premature drop outs) some of them biologic (genotype I, high viral load, advanced fibrosis, insulin resistance, genetic predisposicition, pharmacologic metabolism) requiring an individualized approach. Unfortunately no new drugs are expected for clinical use before the year 2010. Greater dosages or further prolonged treatments with peg IFN-riba induce remission in up to 60% of these patients. Others require pre-treatment support (antidepresives, eritropoyetin, granulocyte stimulating factor). It is important to establish the goals of treatment: viral eradication or diminish viral load for prevention of complications. Hence it is important to select the group of these patients with greater chances to respond to a second treatment, such as patients with genotypes 2-3, low viral load, failures to monotherapies, recurrences to any treatment, partial responders or those whom had incomplete treatments. Different approach require those that had no response to peg IFN-riba where treatment should be reserved for those with greater risk factors. These need induction regimens with higher dosages during the first 20 weeks and then longer treatment (18-24 months). All of these measures not always eradicate HCV, but do slow fibrosis and its complications: liver failure, portal hypertension and hepatocarcinoma.