High-dose Ribavirin in Treatment of Chronic Hepatitis C Genotype 1 or 4

Inclusion Criteria: * hepatitis C genotype 1 or 4 * high viral load (\>400000 IU/ml) * indication for antiviral treatment or patient's desire for antiviral treatment * hepatitis C treatment naive * liver biopsy within 3 years of screening visit or when biopsy is contraindicated e.g in patients with clotting diseases or when a patient refuses to undergo a new biopsy in case the liver biopsy is older than 3 years, substitution by fibroscan is allowed. * age 18-70 years Exclusion Criteria: * serum bilirubin \>35 μmol/l * albumin \<36 g/l * prothrombin time \>4 sec prolonged * platelets \<90x109/l * decompensated cirrhosis (Child-Pugh Grade B or C) * hepatic imaging (ultrasound, CT or MRI) with the evidence of hepatocellular carcinoma (hepatic imaging should be performed within 3 months prior to screening for cirrhotic patients and within 6 months prior to screening for non-cirrhotic patients) * alcoholic liver disease (indicator: MCV\>100) * obesity induced liver disease (indicators: steatosis proven by biopsy or ultrasound in association with a body mass index \>30) * drug related liver disease (indicator: positive history of hepatic toxic drug intake with a causal relation) * auto-immune hepatitis (indicators: IgG \>30g/l, anti smooth-muscle or antinuclear antibodies titer ³1:40) * hemochromatosis (indicator: ferritin \>1000 μg/l) * Wilson's disease (indicator: ceruloplasmin (\<0.2 g/l) * alpha-1 antitrypsin deficiency (indicator alpha-1 antitrypsin \<0.8 g/L) * co-infection with hepatitis B virus or human immunodeficiency virus (HIV) * any cardiovascular dysfunction (e.g. cardiac decompensation, myocardial infarction, present or history of arrythmia) * other medical illness that might interfere with this study: significant pulmonary or renal dysfunction, malignancy other than skin basocellular carcinoma in previous 5 years, immunodeficiency syndromes (e.g.: steroid therapy, organ transplants other than cornea and hair transplant) * contra-indications for peginterferon and/or ribavirin: * severe psychiatric disorder, such as major psychoses, suicidal ideation, suicidal attempt and/or manifest depression. Severe depression would include the following: (a) subjects who have been hospitalized for depression, (b) subjects who have received electroconvulsive therapy for depression, or (c) subjects whose depression has resulted in a prolonged absence of work and/or significant disruption of daily functions. Subjects with a history of mild depression may be considered for entry into the protocol provided that a pretreatment assessment of the subject's mental status supports that the subject is clinically stable and that there is ongoing evaluation of the patient's mental status during the study * visual symptoms related to retinal abnormalities * pregnancy, breast-feeding or inadequate contraception * thalassemia, spherocytosis * females who are pregnant or intending to become pregnant or male partners of females who are pregnant or intending to become pregnant * absolute neutrophil count (ANC) \<1.40x109/l * hemoglobin (Hb) \<7.5 mmol/l (female) or \<8.1 mmol/l (male) * serum creatinine concentration \>1.5 times the upper limit of normal at screening * substance abuse, such as I.V. drugs or alcohol (indicator: \>28 drinks/week). If the subject has a history of substance abuse, to be considered for inclusion into the protocol, the subject must have abstained from using the abused substance for at least 1 year * any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with the patient participating in and completing the study