Table 2 AASLD Recommendations for Treatment of Chronic Hepatitis C
From: Natural history and treatment of hepatitis B virus and hepatitis C virus coinfection
Therapy Widely Accepted | Therapy Contraindicated | Treatment Recommendations |
|---|---|---|
• Detectable HCV RNA • 18 years of age or older • Elevated ALT • Liver biopsy showing chronic hepatitis with significant fibrosis • Compensated liver disease (total serum bilirubin <1.5 g/dL; INR <1.5; albumin >3.4 g/dL; platelet count >75,000 k/mm3; and no evidence of hepatic encephalopathy or ascites) • Acceptable hematological and biochemical indices (hemoglobin >13 g/dL for men and >12 g/dL for women; neutrophil count >1.5 k/mm3; creatinine <1.5 mg/dL) • Not treated previously for HCV infection • History of depression but well controlled • Patient willing to be treated and to conform to treatment requirements | • Major, uncontrolled depression • Renal, heart, or lung transplant recipient • Autoimmune hepatitis or other condition known to be exacerbated by interferon and ribavirin • Untreated hyperthyroidism • Pregnant or unwilling/unable to comply with adequate contraception • Severe concurrent disease such as severe hypertension, heart failure, significant coronary artery disease, poorly controlled diabetes, obstructive pulmonary disease • Under 3 years of age • Known hypersensitivity to drugs used to treat HCV | Genotype 1 HCV infection: • Peginterferon plus ribavirin (1000–1200 mg daily) for 48 weeks • Treatment may be discontinued in patients who do not achieve an EVR at 12 weeks • In patients who have negative HCV RNA at 48 weeks, retest HCV RNA at 72 weeks to confirm SVR Genotype 2 or Genotype 3 infection: • Peginterferon plus ribavirin (800 mg daily) for 24 weeks • In patients who have negative HCV RNA at 24 weeks, retest HCV RNA at 48 weeks to confirm SVR |