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HCV Treatment and Monitoring Guide

August 2003

Treatment

Ultimately the primary goal of HCV treatment is a cure. Another goal is to reduce the amount of virus in the blood, preventing and/or slowing progression of the disease and further damage to the liver.

Your body naturally produces the chemical, alpha interferon. One of the things that it does is boost the antiviral activity of the immune system. All of the currently approved treatments for chronic hepatitis C are made with some form of alpha interferon. Alpha interferon does not attack HCV directly but helps other cells release chemicals that protect them from attack.


Interferon

Alpha interferon can be used either alone or combined with an anti-HCV drug called ribavirin. Combination therapy is much more effective in reducing the hepatitis C viral load to undetectable levels than alpha interferon alone. As a result, it has become the standard of care.

Pegylated interferon is a form of alpha interferon that stays in the body longer than regular interferon. The advantage is the drug does not have to be taken as often. Regular interferon is injected three times a week, while pegylated interferon is taken once a week.

There are two types of pegylated alpha interferons: peg-interferon alfa-2a and alfa-2b. The major difference between the two is how they are dosed. The dose of alfa-2a is the same for all patients, regardless of weight or size. The dosing of alfa-2b is based on an individual's weight.

Short-term side effects of interferon can include flu-like symptoms such as fever, chills, headache, muscle and joint aches and fast heart rate. Side effects that can develop later include tiredness, hair loss, low blood count, trouble with thinking, low white blood cell count (neutropenia), moodiness and depression. Severe side effects are rare but can include thyroid disease, depression with suicidal thoughts, seizures, acute heart or kidney failure, eye and lung problems, hearing loss and blood infection.


Ribavirin

Ribavirin is in the drug category called nucleoside analogues. It is an oral medication taken twice a day. Using ribavirin alone has not been shown to be effective against hepatitis C, but when it's combined with alpha interferon, studies show greater effectiveness than when using alpha interferon alone.

Anemia can develop while taking ribavirin and may result in kidney failure. However, it has been shown that anemia may go away once the treatment is stopped. In addition, some doctors may prescribe Epoetin Alfa (Procrit), a medication used to treat anemia. Some anti-HIV drugs should be avoided when taking ribavirin.


The National Institutes of Health recommends treating patients with chronic hepatitis C using pegylated alpha interferon together with ribavirin. HCV treatment is taken for 6 months to a year and a half. The length of treatment depends on the choice of treatment (interferon alone or combined with ribavirin), HCV genotype and the person's HCV levels before starting therapy.

For people who choose to treat with peg-interferon alone, the recommended length is 48 weeks (about 1 year), regardless of genotype. For people who choose combination therapy, the length depends on the genotype. In general, people with genotype 2 and 3 respond better to combination therapy and 24 weeks (about 6 months) is usually recommended. On the other hand, people with genotype do not respond as well, and therefore 48 weeks is recommended. People who start at a viral load greater than 2 million have a slower response than people who start at less than 2 million.

Studies show that people living with HIV do not respond as well to HCV therapy as HIV-negative people. If you have both HCV and HIV, your doctor may recommend at least 48 weeks of HCV therapy. This could be due in part to the weakened immune system caused by HIV. In addition, people living with HIV may experience more side effects, for example anemia.


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