Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hepatitis C 691

Rx Options

■peginterferon plus ribavirin (Rx of choice)

➣peginterferon: once weekly

➣ribavirin:

➣treat 12 months for genotypes 1a and 1b and viral load >2 mIU;

6 months for other genotypes

➣response rate (loss of HCV RNA): <50% for genotypes 1a and 1b,

>70% for other genotypes

➣response rate less for black patients and obese patients

■peginterferon monotherapy

➣1 year Rx, regimen same as above

➣preferred only for patients who cannot take ribavirin

➣response rate 25–40% overall, less for genotypes 1a and 1b and

for black patients

Side Effects & Contraindications

■interferon

➣side effects: flu-like symptoms (e.g., myalgia, fever), thrombocy-

topenia, depression

➣contraindications

absolute: decompensated cirrhosis, psychosis, organ trans-

plant (except liver), neutropenia thrombocytopenia, uncon-

trolled seizures, severe heart disease

relative: uncontrolled diabetes, autoimmune disease, active

alcohol or substance abuse

■Ribavirin

➣side effects: teratogenic, hemolysis

➣contraindications:

absolute: pregnancy or potential to conceive or father a

child and no reliable contraception, end-stage renal disease,

hemoglobinopathies, anemia

relative: uncontrolled hypertension, active alcohol or sub-

stance abuse

Special Situations

■Children with chronic infection: same protocols as for adults

■HIV-positive patients with chronic infection: same protocols, but

treat only if HIV is well-controlled

■Decompensated cirrhosis: lower response rate and higher risk

of anemia and thrombocytopenia. Rx may be warranted in