Treatment of Chronic Hepatitis C

Indications for PEG-IFN and Ribavirin treatment:

• Detectable HCV RNA in the serum
• Liver biopsy showing chronic hepatitis and fibrosis
• Compensated Liver disease

Contraindications:

• Decompensated cirrhosis
• Pregnancy (the regimen is teratogenic)
• Psychiatric illness
• Also: Substance abuse, Severe cardiopulmonary disease, Uncontrolled DM, Seizure disorder, Autoimmune diseases

Side effects of Peg-IFN and Ribavirin:

• Flu-like symptoms – peak in the first 3-4 weeks
• Bone marrow suppression – neutropenia/thrombocytopenia earlier than anemia
• Fatigue
• Depression/Anxiety – can be a major problem (and a reason why co-existing psych illness is a contraindication)
• Also: SOB, cough, teratogenicity, worsening of autoimmune disease, rarely autoimmune hemolytic anemia, hair loss, rash

Remember that SVR (Sustained Virologic Response) is seen with this regimen in only 40-50% of patients with HCV Genotype 1.  For other genotypes, SVR rates range from 50 to 80%.
New therapies are also very close on the horizon, in the form of HCV Protease Inhibitors like Telepravir and Boceprevir, the subject of many recent published articles including in the NEJM.  Basically, it appears that these drugs, when added to Peg-IFN and Ribavirin, increase the SVR rate by another 20% or so.

(Chanu Rhee MD, 5/16/11)