Treatment of "problematic" hepatitis C patients.

There is limited information about the natural history of hepatitis C in problematic patients and this may affect development of treatment strategies. In patients with persistently normal serum transaminases, infection is often a benign condition which does not require therapy. By contrast, treatment with antiviral drugs is advisable for recipients of renal or liver grafts who may have shortened life expectancies as a consequence of hepatitis C. However, interferon alpha, which is the only available anti-hepatitis C treatment, has limited efficacy in immuno-compromised patients and it may accelerate graft rejection in some. Patients coinfected with the human immuno-deficiency virus (HIV-1) are another group for which treatment is uncertain, mainly because of the short survival times due to HIV-1. Thus, the current policy is not to treat HIV-1/HCV coinfected patients. Symptomatic patients with serum cryoglobulins may respond to interferon therapy, but symptoms recur in virtually all these patients after withdrawal of treatment.