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Hepatitis C virus (HCV) infection frequently causes chronic liver disease leading to cirrhosis and hepatocellular carcinoma (HCC), and HCV-related end-stage liver disease is the main indicator of the need for liver transplantation in Western countries and the leading cause of death amongst cirrhotic patients [1, 2]. To improve the overall outcome and prevent patients from the major long-term complications of chronic hepatitis C (CHC), we have to explore more effective antiviral therapies and more aggressive policies to encourage patients to receive therapies, since in the absence of the effective vaccine for hepatitis C in contrast to hepatitis B, the standard of care (SOC) for antiviral treatment of CHC is combination therapy with pegylated IFN alfa (PegIFN) and ribavirin. The optimal treatment duration and ribavirin dose were investigated in an international multicenter randomized clinical trial [3] and the standard treatment recommendations developed currently according to the HCV genotypes are quite simple to follow. Patients with genotype 1 or 4 are treated for 48 weeks with PegIFN plus ribavirin 1,000–1,200 mg/day and patients with genotype 2 or 3 infection are treated for 24 weeks with PegIFN plus a lower dose of ribavirin at 800 mg/day currently [3, 4]. With the current SOC regimen, the sustained virological response (SVR) rates in Western countries were 42–60% [3, 5, 6] and 76–95% [3, 6, 7] for genotype 1 and 2/3 patients, respectively. The response to the recommended regimens has been observed to be substantially higher in Asian countries [8]. To maximize SVR rates by using the on-treatment viral kinetics [rapid virologic response (RVR): HCV RNA seronegative by PCR (\50 IU/ml) at week 4 and early virologic response (EVR): HCV RNA seronegative or decline more than two logs from baseline at week 12] is the major advance of therapy for CHC. An RVR is one of the best predictors of an SVR for PegIFN plus ribavirin therapy, irrespective of HCV genotype [9–11]. Several studies in Western countries have reported that HCV-1/4-infected patients who have an RVR during PegIFN/ribavirin have high SVR rates when the treatment course is shortened to 24 weeks, in particular among patients with lower baseline viral loads (84–93%). The HCV-2/3-infected patients who have an RVR during PegIFN plus weight-based dose of ribavirin have high rates of SVR (82–90%) when the treatment course is shortened to 12–16 weeks. In Taiwan, truncation of treatment to 16 weeks for genotype 2 patients with a weight-based ribavirin dose for genotype 1 patients achieves 100% of SVR rate [11] and truncation of treatment to 24 weeks for genotype 1 patients with lower baseline viral loads achieves 94–96% of SVR rate [9]. The merits of a shortened treatment regimen, which can be attempted without influencing treatment efficacy, include reducing costs of drugs and medical testing as well as improving tolerability for patients, which ensures compliance throughout the course of treatment. C.-Y. Dai (&) Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, San-Ming District, Kaohsiung 807, Taiwan e-mail: daichiayen@gmail.com

Treatment Uptake of Patients with Chronic Hepatitis C: Can We Expect and Do More?