Optimizing Treatment with Pegylated Interferon-Ribavirin of Genotype 3 Chronic Hepatitis C: More Questions than Answers

Hepatitis c virus (hcv) is the foremost cause of parenterally transmitted non-a, non-b hepatitis. effective treatmentwith interferon (ifn) based regimens has been shown to reduce morbidity and mortality, improve health-relatedquality of life, and avoid the huge costs associated with end stage liver disease. hcv-3 has been associated in europeand the usa to illicit drug abuse in the 70's, while recent epidemiological reports have shown that hcv-3 prevalence ison the rise in both western europe and in middle east. the standard of care for patients with hcv-3 is a 24 week therapyregimen with a combination of pegylated interferon (peg-ifn) and ribavirin (rbv). despite the cumulative high ratesof sustained virological response (svr) obtained with this schedule of treatment, it is now clear that a subgroup ofpatients exists in which lower rates of svr are achieved. bridging fibrosis/cirrhosis, high baseline viremia and lack ofrapid virological response (rvr) have been identified as predictors of treatment failure in many studies. recently,allocation and randomization trials based on hcv-rna negativity at week 4 (rvr) have evaluated the chance ofabbreviating the treatment schedule to 12-16 weeks, since rvr emerged as a strong predictor of svr. in this reviewarticle we will discuss the current therapeutic strategies in hcv-3 to understand in which subset of patients furthertreatment customization is possible.