Hepatitis C (cont.)

Medications

Interferon alpha (Intron A): Interferon is a protein that the body makes naturally in response to viral infections in order to fight the infection. It also has other actions in the body and has been used to treat a variety of diseases such as leukemias, other types of cancers, and multiple sclerosis.

Pegylation describes a chemical process that makes the interferon last longer in the body.

• Levels of the older type of interferon were difficult to regulate in the body. The drug had to be given several times a week. The pegylated type (Pegasys, PEG-Intron) is given only once a week and maintains a steady level in the blood between doses.

• This is a considerable advantage because interferon has to be taken by shot and has many side effects.

• More importantly, though, the pegylated formulation is more effective against HCV.

Because interferon can be harmful to an unborn child, persons taking interferon must practice effective birth control during treatment and for at least 6 months afterward.

Ribavirin (Virazole): Ribavirin is like an antibiotic for certain viruses. By itself, ribavirin has little effect on HCV, but interferon increases its potency. Ribavirin is usually given with interferon unless there is a particular reason not to give it to a specific individual. It has to be taken every day in 2 doses but is a pill rather than a shot.

The combination of interferon alpha and ribavirin works better than interferon alone. The duration of treatment depends on the strain (genotype) of the virus. For genotype 1 and 4, the treatment is given for 48 weeks. For genotype 2, the treatment is only for 24 weeks. During treatment, you will have blood drawn every few weeks to test the effects on your liver, kidneys, and blood.

Treatment is followed by a period of no treatment in which the person's response to the treatment is checked.

• This is measured by the amount of HCV RNA (similar to DNA) in the person's blood.

• The level of HCV RNA goes down to nearly zero during treatment in about 70% of people.

• Treatment is considered successful if the RNA level remains near zero for at least 6 months after treatment. This occurs in about 55% of people treated with combination therapy and about 15% of people treated with interferon alone.

Most people tolerate these drugs fairly well, although side effects are common.

• The side effects range from mild to debilitating.

• If they are severe enough, the person may have to stop taking one or both drugs, or take a lower dose.

• Lower doses generally do not work as well against the disease.

Side effects of interferon can be bothersome in some people. Sometimes the symptoms are described as being like having the flu. The side effects often get better over time as treatment continues. Common side effects include the following:

• Fatigue

• Low hemoglobin level in the blood (anemia) or low blood cell counts

• Muscle aches

• Nausea and vomiting

• Mild fevers

• Depression

• Irritability

• Headaches

• Weight loss

Interferon can have other, less common side effects. You should discuss these with your health care provider before starting treatment.

The side effects of ribavirin can be severe enough that the person has to switch to interferon-only therapy. Like interferon, ribavirin can be harmful to an unborn child, and persons taking ribavirin must practice effective birth control during treatment and for at least 6 months afterward. Common side effects include the following:

• Fatigue

• Anemia

• Irritability

• Itching

• Skin rash

• Sinus congestion and cough

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