الفهرس 
HCV Life cycleOnly 14 pages are availabe for public view
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Abstract
Background: Hepatitis C virus (HCV) infection is a major and growing global health problem and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Currently, treatment is restricted to pegylated interferon alfa (Peg IFNα) and ribavirin (RBV), which leads to a successful outcome in only about 50% of individuals. New effective treatments with tolerable side-effect profiles are needed.
Method: The HCV clinical trials (including the ongoing ones) are assessed as regards the theoretical base for each treatment, its effectiveness and the potential adverse effects. Special attention is paid to trials on genotype 4. The details of each trial are obtained through searching of the MEDLINE database. Summary of the outcome of each trial is prepared including a criticism for each trial and comparison of the trials in each clinical phase is made.
Findings: Sustained virologic response (SVR) rates are significantly high among genotype 4 patients receiving Peg IFNα-2a (180 µg/week) or Peg IFNα-2b (1.5 µg/kg/week) plus RBV(800-1200 mg/day) according to body weight for 48 weeks. Peg IFNα-2a produces a significantly greater SVR rate than peg IFNα-2b but with similar safety profile in patients with chronic HCV infection. Virologic response rates do not differ between the two doses of Peg IFNα-2b (1.0 µg/kg and 1.5 µg/kg) with same adverse events. Viramidine is safer than RBV, even in higher exposures. The Clinical trials report that, there is no significant difference between the 36-week and 48-week treatment regimens.
Antiviral agents specifically targeting either the HCV protease or polymerase as TMC435 are now in clinical development and can result in rapid decline in serum HCV RNA levels. Also, Recent trial reports the safety and efficacy of Nitazoxanide in combination with peginterferon, with or without ribavirin in chronic hepatitis C. Addition of amantadine to Peg IFNα-2a plus RBV, is an effective therapeutic option for patients nonresponsive to previous current treatment, but this is needed to be confirmed in large controlled clinical trial.
Conclusion: Although the combination therapy with Peg-IFN and RBV significantly improves SVR rates, many patients do not respond to this regimen. Thus, new therapeutic options are of great interest to the HCV community. In the last few years, the development of in vitro replication systems for HCV has led to development of many promising anti-viral agents and new hope that more effective therapies will soon emerge.