Patient Education and Treatment Strategies Implemented at a Pharmacist-Managed Hepatitis C Virus Clinic

Bonnie Kolor, Pharm.D.


Pharmacotherapy. 2005;25(9):1230-1241. 

In This Article

Treatment of Hepatitis C Virus Infection

Combination therapy with pegylated interferon (peginterferon) alfa and ribavirin is the standard of care for the treatment of chronic HCV infection. Clinical trials have shown that more than 50% of patients with HCV infection treated with combination therapy achieved a sustained viral response, defined as undetectable HCV RNA in the blood 6 months after the end of treatment.[7] In addition, pharmacoeconomic analyses have shown that the combination of peginterferon alfa plus ribavirin is more cost-effective than previously used therapies in the treatment of HCV.[13,14]

Absolute contraindications to treatment with peginterferon alfa and ribavirin are pregnancy; unwillingness of women with childbearing potential or their partners to practice two reliable forms of contraception throughout the treatment period and during a 6-month follow-up period; uncontrolled major depression; heart, lung, or kidney transplant; and presence of severe comorbidities, such as uncontrolled hyperthyroidism, poorly controlled diabetes, autoimmune hepatitis, and hemoglobinopathies.[7,15,16] Treatment is also contraindicated in children younger than 3 years and in women who are breastfeeding.[7,15,17] Men undergoing treatment should not be sperm donors.[17]

Treatment can be considered for patients with HCV who are coinfected with human immunodeficiency virus (HIV), those with a recent history of alcohol or drug abuse who are enrolled in a substance abuse treatment program, those who have not responded to or have relapsed after previous treatment with interferon with or without peginterferon or ribavirin monotherapy, children aged 3-18 years, and liver transplant recipients.[7] One recent study showed that 40% of patients coinfected with HCV and HIV achieved a sustained viral response after treatment with peginterferon alfa-2a and ribavirin combination therapy.[18] However, decisions regarding treatment of these patients must be based on likelihood of adherence to the therapeutic regimen and other considerations specific to each patient.

Long-term therapeutic regimens typically consist of 24 weeks for patients with HCV genotype 2 or 3, and 48 weeks for those with genotype 1.[7] The requirement for long-term treatment, the need to administer peginterferon alfa weekly by subcutaneous injection, and the drugs' adverse-event profiles are factors that may lead a patient to terminate treatment prematurely. Since clinical studies have shown that treatment success is associated with adherence to the recommended therapeutic regimen, especially for patients infected with HCV genotype 1, effective drug therapy management can facilitate a successful outcome for patients with HCV infection.[19]


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