There is good evidence from randomised controlled trials that adding ribavirin to interferon alfa produces important benefits for patients, both in patients not previously treated and in those who have received interferon alfa but have relapsed. These benefits are in terms of sustained virological response (defined as absence of detectable virus in the blood six months after the end of treatment). This is an intermediate outcome measure, but it is believed to be a reliable indicator of long-term cure.
Both interferon alfa on its own, and in combination with ribavirin, are expensive treatments. Treatment with combination therapy should be offered to carefully selected patients according to agreed local protocols. It should not be prolonged past three months in those who fail to respond. This is a rapidly developing field and patients should be invited to participate in research programmes investigating other aspects of treatment (including the duration and targeting of treatment and the use of new therapies).