Aims of hepatitis C virus treatment

The main goals of hepatitis C treatment are:

• Sustained virological response (SVR), or undetectable HCV viral load (below 100 copies/ml) six months after completing a course of treatment.

• Undetectable, or significantly reduced, HCV viral load within three months of starting treatment. This is strongly predictive of achieving long-term virological response.

• Sustained normalisation of ALT levels.

• Improvement or disappearance of liver inflammation and associated symptoms.

• Prevention or reversal of progression to cirrhosis, liver cancer and liver failure.

• Reduction or delay of liver-related mortality.

• Improved quality of life.

• Among people with HIV / HCV co-infection, an additional aim is to improve tolerance of anti-HIV drugs.

Although it is often assumed that undetectable HCV viral load after a 24- or 48-week course of therapy signals the complete clearance of the virus, an editorial in the New England Journal of Medicine urged caution in describing undetectable HCV in the blood as a 'cure' for HCV.¹ This caution is supported by the fact that HCV usually recurs after a liver transplant, even among people who previously achieved SVR, indicating that the virus was still present at low levels in the body.

Several recent studies indicate that even amongst people who are not long-term responders, interferon-based treatment still seems to reduce, and possibly even reverse, the level of liver damage.² Several recent studies of peginterferon in HIV-negative individuals reported improvements in liver tissue health in some patients who still had detectable HCV viral load at week 72, suggesting that interferon may still benefit liver health even if it cannot completely control HCV viraemia. Clinical trials are underway to determine whether low-dose interferon maintenance therapy can help prevent progressive liver damage.