Interferon and ribavirin combination therapy: indications and schedules.

Treatment outcome for patients with chronic hepatitis C virus infection has greatly improved during the last years with the development of interferon (IFN) and ribavirin combination therapy. The final decision to treat or not, however, is complex and should be based on several factors such as the age of the patient, the general health, the risk of developing cirrhosis and the probability of a cure with treatment. Combination therapy with standard doses (IFN-a 3 x 106 IU three times per week plus ribavirin 1000-1200 mg daily in two divided doses) for six (up to 12) months significantly improves the sustained biochemical and virological response rates 2-3 times as compared to IFN alone given during 12 months. Combination therapy has thus become standard therapy for na ve patients and relapse patients after a prior IFN treatment course. For patients with favourable baseline viral characteristics (genotype 2 and 3 irrespective of viral load) six months combination therapy is sufficient whereas patients with unfavourable viral baseline characteristics (genotype 1 with high baseline viral load) will need 48 weeks combination treatment. In addition, for patients with compensated cirrhosis, combination therapy is superior and better tolerated than IFN monotherapy. For the future better optimised treatment schedules and dosing regimens for IFN in combination with ribavirin need to be worked out and individualised according to genotype to further improve treatment results. Utilisation of new IFN formulas such as pegylated IFN and consensus IFN in combination regimens will probably improve treatment further.