Hepatitis C (cont.)

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How are relapses and nonresponders treated?

  • The optimal treatment for nonresponders and relapsers is not well established.
  • A minority of nonresponders (6% to 12%) will respond to a second course of pegylated interferon and ribavirin.
  • Patients initially treated with older nonpegylated interferon can be considered for the therapy with either pegylated interferon or pegylated interferon plus ribavirin therapy.
  • Newer preparations of interferon and protease inhibitors are being studied and show promise in persons who did not respond to combination therapy.

Despite the failure to achieve sustained virologic response, treatment may slow the progression of HCV to cirrhosis, although this has not been shown for certain.

Should individuals with acute hepatitis C infection be treated?

When people first acquire HCV, the infection is said to be 'acute'. There is no standard approach to treatment for acute HCV. Most patients with acute HCV do not have symptoms, so they are not recognized as being infected. However, some have low-grade fever, fatigue or other symptoms that lead to an early diagnosis. Others who become infected have a known exposure to an infected source, such as a needlestick injury, and are monitored closely. Treatment decisions should be made on a case-by-case basis. Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient eliminates the virus without treatment.

What are the side effects of treatment for hepatitis C infection?

Flu-like symptoms, hair thinning and depression are common side effects of interferon or pegylated interferon. Depression may be serious and is common enough that patients should be monitored for this side effect.

Interferons may cause transient bone marrow suppression resulting in reduced white blood cell and/or red blood cell counts (leucopenia and anemia, respectively). Reductions in white blood cell counts may cause increased susceptibility to infection. Growth factors (erythropoietin) can be used to improve the anemia associated with interferon. Death rarely occurs as a result of therapy, but may occur from progressive liver failure in patients with advanced cirrhosis.

Certain side effects are attributed to the addition of ribavirin to interferon, including nausea, cough, shortness of breath, rash, itching, insomnia, and loss of appetite.

Ribavirin also causes anemia due to the destruction of red blood cells (hemolysis). This anemia is usually mild but can become clinically significant. Ribavirin particularly may cause destruction of red blood cells (hemolysis) in people with kidney failure. Anemia improves with a reduction in the dose of ribavirin.

Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans as yet, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.

Medically Reviewed by a Doctor on 2/2/2014

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