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Treatment of chronic hepatitis C: lessons from human immunodeficiency virus dynamics.

Treatment of chronic hepatitis C is a major problem. A sustained viral response to interferon alpha monotherapy occurs in <20% of patients. Using a combination therapy of interferon alpha and ribavirin. the sustained response rate in naive hepatitis C patients has increased to 31%-47%. The success of therapy for chronic hepatitis C depends on both virus- and host-related factors, such as age, histology, duration of hepatitis C virus (HCV) carriage and biochemical parameters. During the last 5 years, insight into the dynamics of human immunodeficency virus (HIV) has been obtained by analysing the changes in viral load after starting antiviral treatment. By using a mathematical model of HIV kinetics as an example, an exponentially rapid decline in serum HCV RNA level was seen after the first dose of interferon alpha, followed by a slower exponential decline: a so-called biphasic pattern. The estimated virion half-life varies between 2.7 and 16.8 h. The high virion turnover allows the generation of a heterogeneous quasi-species population of HCVs. It is therefore supposed that initial aggressive treatment can be helpful to prevent the development of mutations that make the virus more defensible for the interferon alpha treatment. Various trials are now being conducted based on this principle of high induction antiviral therapy.