[Chronic hepatitis C--patients "difficult to treat"].

: Among "patients difficult to treat" there are infected with genotypes 1,4 HCV, patients with liver cirrhosis, blacks, immunocompromised, hemodialyzed and non-responders to previous treatment. Multicenter, randomized trials were confirmed lower sustained virologic response (SVR) in patients infected with genotype 1 HCV. To improve the response longer therapy during 72 weeks was suggested. In genotype 4 HCV infected relationship of therapeutic efficacy with patients ethnicity was shown. The standard of HCV therapy in HIV infected patients is combined therapy with pegylated interferon and ribavirin. This therapy depends of the advance of HIV infection and administered antiretroviral therapy. Pharmacokinetic examination of safety and tolerability of pegylated interferon in patients with renal insufficiency was revealed the base to administering it in these patients. Controversial in this group is administering of ribavirin. Relationships between body weight, body mass index, obesity, liver steatosis, insulin resistance and therapeutic response in patients with chronic hepatitius C are analyzed. Trials assessed the efficacy of retherapy with pegylated interferon and ribavirin patients, who non responded to previous therapy revealed positive results.