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New HCV Treatment Options Available

By Alan Franciscus

September 20, 2004

New decisions by the Food and Drug Administration (FDA) offer more choices and better treatment options for people living with hepatitis C virus (HCV).

More Ribavirin Choices

Ribavirin is a nucleoside analogue drug -- a chemical cousin of AZT. It is taken twice a day in the form of a pill. While it is not effective against HIV, it packs a powerful punch against HCV when taken with interferon. Two brand name versions of ribavirin are available, called Rebetol and Copegus. Both seem to work equally well.

Recently, the FDA approved two generic versions of ribavirin. Generic drugs usually cost less than the same brand name drug. The price of generic ribavirin should fall as more companies start to sell it. Doctors can prescribe any kind of ribavirin with any available kind of interferon. Ribavirin does not work by itself and must be combined with interferon to treat HCV.

Ribavirin can cause many side effects including fatigue, itching, skin rash and a dry cough. People who have anemia (low red blood cell count) or heart problems should not take ribavirin. It can also cause birth defects, so people taking ribavirin and their sexual partners must use birth control.

Levels of the HIV drug Videx (ddI) are increased if it is taken with ribavirin. Talk to your doctor about the risks of combining these drugs. If you do take Videx with ribavirin, you should be monitored closely for Videx side effects, including pancreatitis, lactic acidosis and peripheral neuropathy.

Two Versions of Pegylated Interferon Approved

Interferon, an important HCV drug, is available in an improved, time-release form called pegylated interferon. Two versions of pegylated interferon are available: Peg-Intron and Pegasys.

The combination of pegylated interferon plus ribavirin works better than standard interferon plus ribavirin to fight HCV. The side effects of pegylated interferon are similar to those of standard interferon. They can include muscle aches, joint pains, anxiety and depression.

Pegylated interferon is given by injection just under the skin. A big improvement with pegylated interferon is that you only have to inject it once a week instead of three times a week. Data from clinical trials show that pegylated interferon plus ribavirin can get rid of HCV in more than half of people who take this combination.

The two types of pegylated interferon have some significant differences. We do not yet know whether one version works better or causes fewer side effects, but some experts think Pegasys may be a better drug. Clinical trials are currently comparing the two.

People who are coinfected with HIV and HCV can benefit from these new treatment options, but should speak to their doctors about their own situations.

Alan Franciscus is the Executive Director of the Hepatitis C Support Project in San Francisco and Editor-in-Chief of the HCV Advocate newsletter (

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