Practical approach to retreatment

When deciding retreatment of previous non-sustained
responders to standard therapy, the following practical issues
should be considered:
– Patient’s motivation for another course of therapy. Lower
likelihood of SVR in treatment-experienced patients, side
effects, poor QoL should be discussed with the patient;
– Severity of liver disease (clinical, biochemical,
histological). Patients with minimal-to-moderate fibrosis
50 | Hepatitis C Treatment
may wait for triple therapy while patients with advanced
fibrosis should be treated immediately with available
regimens;
– Virological response during the initial course of therapy.
Null and partial responders achieve lower SVR rates as
compared with relapsers, irrespective of therapeutic
regimen. Slow virological responders who have relapsed
may benefit from extending duration of therapy;
– Previous dose regimen and adherence assessment.
Optimizing RBV dosing, minimizing dose reductions by use
of growth factors and avoiding premature discontinuations
are important issues during retreatment;
– Correctable factors that may affect the subsequent
response to therapy: steatosis, insulin-resistance, chronic
alcohol consumption etc.