Clinique universitaire d'hépato-gastroentérologie, Unité Inserm/UJF U823 IAPC Institut Albert-Bonniot, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9
The treatment of chronic hepatitis C is based on the combination of pegylated interferon and ribavirin. However, non response is usually observed in 31-35% of cases. The therapeutic failure can be due to co-morbidities, especially overweight associated with insulin resistance and alcohol consumption. The compliance is very important in particular for ribavirin taking in the first weeks of treatment. The using of hematopoietic growth factors especially epoietin which should be proposed in order to maintain the same dose of ribavirin. Recently a genetic polymorphism has been identified located on chromosome 19 near the interleukine-28B gene encoding interferon-λ-3, that is associated with a two-fold difference in response to treatment with pegylated interferon and ribavirin in patients infected with HCV genotype 1. The re-treatment by the same schedule of pegylated interferon and ribavirin leads to a sustained virological response in less than 10% of cases. An increasing dose of pegylated interferon is not a good option. Increasing the dose of ribavirin remained to test in therapeutic trials. A maintenance therapy by pegylated interferon alone is usually associated with an improvement of necro-inflammatory lesions but the gain in term of fibrosis rate is very low. A new therapeutic approach is the using of antiprotease or antipolymerase inhibitors in combination with pegylated interferon and ribavirin.