The optimal management of chronic hepatitis C 1, the current treatment of chronic hepatitis C, the efficacy of long-acting interferon is significantly better than ordinary interferon. The efficacy of long-acting interferon is better than that of ordinary interferon, with a difference in efficiency of 20% to 30%. For chronic hepatitis C, if the first treatment fails, a second treatment is more difficult. Chronic hepatitis C can be cured, so I believe that the first treatment should be with a drug that has good efficacy and aim for a single cure. There have been many cost-benefit analysis studies comparing the cost and benefit ratio of long-acting interferon and regular interferon therapy. The final conclusion of these studies is that it is not only more cost effective to use long-acting interferon for the first treatment, but also has a higher cure rate. We do not recommend choosing regular interferon therapy, because after judging that the treatment is not effective, then switching to a regimen of long-acting interferon is not only more expensive, but also delays the treatment. 2. The Asia-Pacific guidelines clearly state that the efficacy of PEG-IFN-α2a is superior to that of PEG-IFN-α2b, is this also true for treating patients in the clinic? The results of the meta-analysis indicate that PEG-IFN-α2a is more likely to be effective than PEG-IFN-α2b for the treatment of hepatitis C. Different clinical trials have differences in trial design, patient inclusion criteria, and different drug dose adjustments in the trials, so the conclusions of individual studies are prone to bias. In contrast, meta-analysis is a comprehensive analysis of multiple studies that can meet the criteria, thus reducing the bias between the results of individual studies, and the level of evidence obtained is higher and can be used as a basis for clinical treatment preferences. Because PEG-IFN-α2a treatment has a greater probability of being effective, if PEG-IFN-α2a treatment is ineffective, switching to PEG-IFN-α2b is unlikely to be effective; conversely, if PEG-IFN-α2b treatment is ineffective, switching to PEG-IFN-α2a may be effective. Both drugs are identical in terms of price and side effects. In clinical practice, we will choose a drug with a high probability of cure, which can increase the treatment efficiency by 2% or 5%. 3. In the standard treatment of PEG-IFN-α combined with ribavirin, a higher cure rate can be obtained if individualized treatment is used. In your clinical work, do you have different treatment regimens for different patients, what are the main adjustments and what are the results? First of all, let’s be clear that the effectiveness of treatment of chronic hepatitis C is related to the dose of interferon and ribavirin within a certain range. Before treatment, we must first assess whether the patient is a refractory patient. Factors to be assessed include the presence of diabetes, obesity, and the patient’s degree of liver fibrosis, genotype of the virus and viral load, all of which may affect the effectiveness of treatment. If a patient has refractory chronic hepatitis C, it is important to use a full dose of therapy at the start of treatment, rather than waiting until it is less effective and then increasing the dose. Treatment of chronic hepatitis C begins with achieving an undetectable level of virus (<15 IU/mL) after initiation of therapy, and the time required to reach this level varies among patients. In general, the shorter the time to achieve true undetectable virus, the more effective the treatment will be. This is why in clinical practice we recommend that patients monitor their viral load at 1 month, 3 months and 6 months to determine whether they will eventually achieve a sustained virological response, or SVR. If the virus turns negative within 1 month of treatment, this means that the probability of patients achieving SVR can be 90-95% with continued treatment; if the virus turns negative only after 3 months of treatment, the SVR rate is relatively lower, about 80%. In addition, if there is little decrease in viral load after 1 month of treatment, it is possible that the dose of interferon and ribavirin treatment is not sufficient, and then it is necessary to increase the dose, the purpose of which is to increase the probability of viral regression and shorten the treatment time, so as to further improve the effectiveness of treatment. In clinical practice, we often need to adjust the dose according to the response situation. Of course, it is not the case that the higher the dose is the better. The dose is too high for the patient to tolerate the side effects, and it is also necessary to lower the dose. The purpose of adjusting the dose is to make the adjusted dose so that the patient can tolerate its side effects and at the same time has no great impact on the efficacy, i.e., to achieve a balance point between side effects and efficacy, and only such a treatment plan can ensure that the patient persists. It is impossible to maximize the efficacy if the drug dose is mechanically given or adjusted according to the drug instructions.