Man With Hepatitis C Infection: Making Treatment Decisions
By ANDRÉ N. SOFAIR, MD, MPH |
April 1, 2006
Dr Sofair is assistant professor of medicine at Yale University School of Medicine, New Haven, Conn, and a principal investigator in the
Connecticut Emerging Infections Program, a collaborative effort of the Connecticut Department of Public Health and the Centers for Disease
Control and Prevention.
THE CONSULTANT'S CHOICE
The wise choice here is A. Ribavirin(Drug information on ribavirin)
hemolytic anemia. In up to 10% of patients, the situation
is serious enough to necessitate a reduction in dosage.16
However, a reduction in ribavirin dosage is associated
with a decreased virologic response29
; thus, it is appropriate
to reduce the dosage or discontinue the drug altogether
only when necessary. A reduction in ribavirin dosage
to 600 mg/d is advised when hemoglobin levels decrease
2 g/dL or more over a 4-week period in patients with cardiac
disease, or when the level drops to less than 10 g/dL
in all others.30 Erythropoietin(Drug information on erythropoietin)
can limit ribavirin-associated
anemia and enable some patients to continue with the
Permanent discontinuation of ribavirin may be necessary
in patients with cardiovascular disease whose hemoglobin
level is persistently below 12 g/dL or in anyone
whose hemoglobin level is consistently below 8.5 g/dL.
Flu-like symptoms are very common in patients receiving
interferon therapy. They usually abate as therapy
continues, and their presence does not justify a reduction
in dosage or discontinuation of the medication.
Our patient remained on his initial treatment
regimen, and his hemoglobin level remained stable
(without intervenion) for the duration of therapy. A
viral load measurement taken after 24 weeks revealed
undetectable levels of HCV. The patient successfully
completed 48 weeks of treatment, and a viral load measurement
taken 6 months post-treatment also showed
In those who demonstrate a sustained virologic response,
as our patient did, infection recurs in fewer than
10% of patients during the subsequent 5 to 10 years. Histologic
injury also appears to improve over time.32,33
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