This volume is devoted to three important issues and attendant controversies surrounding the current therapy of hepatitis C. The first chapter provides an up-to-date analysis of the antiviral management of acute hepatitis C. In most Western countries, the incidence and public health impact of new hepatitis C virus (HCV) infections are low relative to the burden represented by chronic hepatitis C cases. In areas with limited resources, however, acute infections with HCV are still frequent and, given their high rate of progression to persistency and the scarcity of therapeutic intervention, they contribute to maintaining a high prevalence of HCV infection and disease. And yet, acute hepatitis C is a nosological entity for which interferon alfa treatment has proved to be very successful, provided that adherence and tolerability do not represent a significant barrier, as may be the case in the drug addiction setting. Some debate still exists regarding the optimal time-point for treatment initiation, optimal treatment duration, and interferon dosage; however, despite this, the success rate of antiviral therapy, as confirmed by several clinical trials, is remarkable.
At the other end of the spectrum, there is the daily increasing population of chronic hepatitis C patients who have failed a previous course of therapy, using either the conventional or pegylated form of interferon alfa combined (or not) with ribavirin. How (and whether) to re-treat such patients is the subject of the second chapter. Clearly, new treatment schedules incorporating novel antiviral molecules are eagerly awaited, as the available data suggest that these new agents have efficacy also in difficult-to-treat patient populations. Meanwhile, treatment options are limited, so that special care should be devoted to re-treatment individualization, whenever feasible.
The third and final chapter addresses treatment optimization. Among the options used to refine and optimize currently available regimens, tailoring the duration according to on-treatment response is an intuitively alluring approach (the so-called ‘accordion’ principle). However, proceeding from theory to application in everyday patients – both naïve and therapy-experienced – has proven difficult, and a consensus on what regimen may work in what sort of patients is still lacking.