Hepatitis C: Treatment

The only approved drugs for the treatment of chronic hepatitis C are:

Interferon monotherapy

– dose of 3 million units subcutaneously three times a week
– response rate of 15-35%, response depends on the degree of hepatic fibrosis plus other factors
– length of treatment is 1 year
– effectiveness of response determined 6 months after end of treatment
– must monitor carefully for side effects

Interferon plus ribavirin combination therapy

– combination marketed as Rebetron
– ribavirin alone is not effective
– response rate of 25-47%
– length of treatment is 6 to 12 months (genotype may eventually determine after more research studies)
– dose of ribavirin is 1000 or 1200 mg in bid dose
– dose of ribavirin determined by weight, (below or over 75 kg.), hemoglobin, presence of cardiac disease, presence of pulmonary disease amongst other factors
– must monitor carefully for side effects

Quality treatment requires expertise and includes: ¨ careful pre-treatment assessment (see volume 1 number 5)
¨ assessment for contraindications (see volume 1 number 5)
¨ adequate teaching
– about the drugs and possible side effects
– about pyschological factors
– how to self inject – employment issues
– about nutritional factors
¨ a plan for monitoring and follow-up

Side effects of the medications:

– Side effects are highly variable, some patients feel better on treatment, some feel the same, about 60% have some adverse effects.
– There are many potential side effects from inteferon, there are few side effects from ribavirin. Ribavirin does not potentiate the side effects of interferon.
– Some of the more common side effects of interferon are:

– fever post injection
– depression
– muscle and joint aches
– thrombocytopoenia – fatigue, malaise
– neutropoenia
– weight loss, average 15 pounds
– hair loss
– induction of other autoimmune diseases:
* diabetes, psoriasis, lichen planus,thyroid disease
– thrombocytopoenia

– The side effects are maximal in the first two weeks and improves somewhat after that.

– Some of the more common side effects of ribavirin are:
– hemolytic anemia
– shortness of breath
– possibly accentuation of cardiac disease
– diarrhea

– Dose reduction of either interferon or ribavirin may be necessary
– interferon may have to be lowered if platelets or WBC are too low
– ribavirin may have to be lowered if hemoglobin falls too low

Monitoring is intense and time consuming and requires:
Clinical monitoring requires:
¨ intense and time consuming supervision
¨ assessment of injection protocol, (storage of medication, etc.) compliance and injection site
¨ check of psychological and emotional status
¨ assesment for depression
¨ assessment of vital signs including weight and nutrition
¨ monitoring of employment and ability to work
¨ signs of other autoimmune diseases
¨ check of cardiac status

Hematological and biochemical monitoring:
¨ every two weeks for the first two months or longer if platelets or hemoglobin unstable
¨ monthly thereafter
¨ parameters include:
– hemoglobin
– WBC and differential
– platelets
– AST and ALT
– blood sugar and thyroid if indicated

Check for other lifestyle factors:
¨ alcohol use, drug use
¨ other medications
¨ use of herbs and other naturopathic medications

Special concerns during treatment:
– Bacterial infections may be increased
– Pre-existing conditions may worsen
– psoriasis
– arthritis
– lichen planus
– thyroid disease
– diabetes

– The patient’s injection technique should be checked periodically

– Counseling should be made available

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