Hepatitis C (cont.)
In this Article
What are the goals of therapy for hepatitis C virus?
The ultimate goals of antiviral therapy are to eliminate HCV, improve or
normalize the liver tests and histology (microscopic
appearance), prevent
progression to cirrhosis and liver cancer, prolong survival, and improve the
quality of life.
As already indicated, only a sustained virologic response provides the
possibility of achieving all of the ultimate goals, since most patients who have
an SVR will remain in remission indefinitely. The rest of the patients
(non-responders, partial responders and relapsers) may show improvement in blood
tests with or without relief of symptoms.
What are the therapy options for previously untreated patients with chronic hepatitis C?
For previously untreated patients without reasons to be
excluded from treatment, the optimal treatment is combined treatment with
pegylated interferon
and ribavirin (Rebetol, Copegus). Patients who have reasons not to receive ribavirin may be treated
solely with pegylated interferon. Older preparations of interferon are less
effective and less commonly used.
Pegylated interferon
Interferons are a family of naturally occurring proteins that are produced by
the body to fight viral infections. To produce
pegylated interferon, the
interferon is processed by attaching ethylene glycol to it. This process is
called pegylation and it slows the elimination of interferon from the body so
that its effects are more prolonged. There are currently two types of pegylated
interferon: pegylated interferon alpha 2b (Peg-Intron A) and pegylated
interferon alpha 2a (Pegasys). Both pegylated interferon alpha 2b and 2a; are
given as a subcutaneous injection once a week.
Optimally, pegylated interferon therapy should be combined with ribavirin. In
persons who cannot take ribavirin, monotherapy with pegylated interferon may be
used. Monotherapy has been shown to achieve sustained virologic response rates
of 23% to 25% in patients.
Ribavirin
The antiviral agent,
ribavirin (Rebetol, Copegus), is a nucleoside analogue that is taken by mouth.
Nucleoside analogues are man-made molecules that closely resemble the
biochemical units that make up genetic material (RNA and DNA). Ribavirin works
by fooling the virus into using it instead of the normal building blocks,
thereby slowing viral reproduction. Ribavirin has not worked
well when used alone for hepatitis C.
Combined pegylated interferon and ribavirin
- Combined therapy with both pegylated interferon and ribavirin produces a
sustained virologic response in 28% to 50% of patients with genotype 1.
- For
unknown reasons, response rates are lower in African American persons and higher
in Caucasians.
- In patients with genotype 2, sustained response rates are higher
(76% to 82%).
- The duration of therapy depends on the genotype of the HCV.
- Hence
the recommended duration of treatment for HCV genotype 2 and 3 is 24 weeks and
for genotype 1 is 48 weeks.
- Sustained virologic response usually is accompanied
by a return to normal serum ALT levels and improvement in inflammation within
the liver.
Combination therapy is associated with more side effects than monotherapy
(see below). In research studies, up to 20% of patients receiving combination
therapy required a reduction in the doses or discontinuation of therapy because
of the side effects. Nevertheless, combination therapy represents significant
progress in the treatment of chronic HCV and is the current standard of care.
Some patients treated successfully with combination therapy still have
detectable virus after 12 weeks of treatment but go on to have a sustained
response. Therefore, patients on combination therapy should have hepatitis C
virus RNA measured at 24 weeks of therapy. In those who are still positive for
the virus at that time, consideration is given to stopping treatment, since the
chance of sustained response is small.
Next: How are relapses and nonresponders treated? »
- interferon - Describes the medication interferon (Roferon-A, Intron-A, Rebetron, Alferon-N, Peg-Intron, Avonex, Betaseron, Infergen, Actimmune, Pegasys), a drug used in managing many diseases that involve the immune system.
- Liver Blood Tests - Learn about liver blood tests used to detect liver damage disease such as fatty liver, cirrhosis, hepatitis, Tylenol liver damage, and more. This includes measuring the aminotransferases enzymes (AST and ALT levels)
- Diabetes - Learn about type 1 and 2 diabetes (Diabetes Mellitus) symptoms including increased urination, thirst, weight loss, fatigue, nausea, vomiting, skin infections, and blurred vision. Causes and diagnosis information is provided in the information.
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