Nonresponders to hepatitis C virus antiviral therapy: pegylated interferons and beyond

Nonresponders to prior antiviral therapy are a heterogenous but growing population of hepatitis C patients in the United States. The likelihood of response to retreatment with pegylated interferon (PEG IFN) and ribavirin (RBV) is largely dependent upon hepatitis C virus genotype and the type, duration, and response to prior antiviral therapy. Investigational trials with clinical and histological endpoints for nonresponders with advanced fibrosis including maintenance PEG IFN and other antifibrotic agents should be completed in the next 5 years. In the interim, decisions regarding retreatment with PEG IFN and RBV should be made on a case-by-case basis after considering the tolerability of prior treatment, the severity of underlying liver disease, and the anticipated likelihood of response.