November 30, 2015
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Hepatitis C (cont.)

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What is the treatment for hepatitis C infection?

There are six genotypes of hepatitis C, and they may respond differently to treatment. Careful screening is necessary before starting treatment to determine the best treatment for the patient.

Combination antiviral therapy with interferon injection and oral ribavirin (Rebetol, Copegus, Ribasphere, RibaPak, Moderiba) has been the mainstay of hepatitis C treatment in the past. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, many people who take interferon do not finish their treatment, and only 60% of patients respond to the treatment. This means that while hepatitis C is generally considered to be a curable disease, for many people this was not a reality.

Pegylated interferon: Interferons are a family of naturally occurring proteins that are produced by the body to fight viral infections. To produce pegylated interferon, the interferon is processed by attaching ethylene glycol to it. This process is called pegylation and it slows the elimination of interferon from the body so that its effects are more prolonged. There are currently two types of pegylated interferons.

  • pegylated interferon alpha 2b (Peg-Intron A), and
  • pegylated interferon alpha 2a (Pegasys).

Both pegylated interferon alpha 2b and 2a; are given as a subcutaneous injection once a week.

Optimally, pegylated interferon therapy should be combined with oral ribavirin. In persons who cannot take ribavirin, monotherapy with pegylated interferon may be used; however, monotherapy has been shown to achieve sustained virologic response rates of only25%. Older preparations (nonpegylated forms) of interferon are even less effective than pegylated interferon.

Ribavirin: The antiviral agent, ribavirin (Rebetol, Copegus), is a nucleoside analogue that is taken by mouth. Nucleoside analogues are man-made molecules that closely resemble the biochemical units that make up genetic material (RNA and DNA). Ribavirin works by fooling the virus into using it instead of the normal building blocks of RNA, thereby slowing viral reproduction. Ribavirin has not worked well when used alone for hepatitis C.

Combined pegylated interferon and ribavirin: Combined therapy with both pegylated interferon and ribavirin produces a sustained virologic response or cure in 28% to 50% of patients with genotype 1. (Genotype 1 is the most common genotype in the U.S., but also the most resistant to treatment.) For unknown reasons, response rates are lower in African American persons and higher in Caucasians. In patients with genotype 2, sustained response rates are higher (76% to 82%). Duration of therapy depends on the genotype. Recommended duration of treatment for Genotype 1 is 48 weeks and for genotype 2 and 3 is 24 weeks.

Combination therapy is associated with more side effects than therapy with pegylated interferon alone. (See below.) In research studies, up to 20% of patients receiving combination therapy required a reduction in the doses or discontinuation of therapy because of the side effects. Nevertheless, combination therapy represented significant progress in the treatment of chronic hepatitis C.

Some patients treated successfully with combination therapy still have detectable virus after 24 weeks of treatment. Few of these patients go on to have a sustained response. Therefore, patients on combination therapy should have hepatitis C virus RNA measured at 24 weeks of therapy. In those who are still positive for the virus at that time, consideration is given to stopping treatment, since the chance of a sustained response with further treatment is small.

Medically Reviewed by a Doctor on 5/26/2015


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