Topic: Hepatitis C, June 2000

Dr. Lee:
Who are NOT candidates for treatment?

Dr. Edward Block:
Well, there are some absolute and some relative contraindications to treatment. (Contraindication means factors that render treatment in this person too risky).

Absolutely people who are drinking alcohol are not candidates for treatment. Excess alcohol consumption reduces the response rate. (Alcohol also aggravates liver damage). Furthermore, there are problems with depression, and problems with compliance. We are not optimistic that this group of patients are going to be able to follow this difficult course of treatment.

We have also learned that people with renal (kidney) insufficiency or advanced kidney disease may have problems with treatment. These people have to be considered individually and carefully as they can have very serious side effects to treatment, particularly to the ribavirin pill.

There are some relative contraindications because certain people would have possible problems with treatment. They are:

  1. Patients with seizure disorders, although if these seizures are controlled generally treatment can be initiated.
  2. Treatment can aggravate depression, thus we have to be careful in patients who have had problems with depression or suicide risks in the past.
  3. Patients with coronary or heart disease might develop angina (chest pain) if they become too anemic with ribavirin treatment. I guess the best recommendation there would be is that any decision to treat this group of patients would be done in conjunction with the advice of the treating cardiologist.

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