Combination therapy with interferon and ribavirin in the treatment of chronic hepatitis C infection

OBJECTIVE: To review and critique the medical literature regarding the combination of interferon and ribavirin in the initial treatment of chronic hepatitis C virus (HCV) infection. DATA SOURCES: A MEDLINE search (January 1966-June 1999) was conducted to identify human clinical trials regarding the combination of interferon and ribavirin therapy for the initial treatment of chronic HCV. Bibliographies were reviewed for relevant literature. STUDY SELECTION: Clinical trials of combination interferon and ribavirin for the treatment of chronic HCV in interferon-naive adults were reviewed. DATA SYNTHESIS: The combination of ribavirin and interferon in the treatment of chronic HCV has been beneficial in patients who are interferon-naive. Patients with predictors of poor response, such as baseline cirrhosis, male gender, age >40 years, high baseline viral loads (>2 x 10(6) copies/mL), and genotype 1 respond better to combination treatment when compared with those who receive interferon monotherapy. Patients with genotype 1 and/or high viral loads may benefit most from 48 weeks of combination therapy; however, adverse effects are of greater concern in these patients. Monitoring can limit these complications. CONCLUSIONS: Combination therapy is effective in the treatment of interferon-naive patients with chronic HCV infection. Patients should be evaluated for duration of treatment with combination therapy by determination of predictors of response. Further trials are needed to more closely evaluate the duration of treatment and to determine the best patient population to receive combination therapy.