ABSTRACT
Patients infected with hepatitis C virus (HCV) genotype 1 and with serum HCV RNA concentrations over 800 000 IU/mL have relatively low rates of virologic response to pegylated interferons. The 2 forms of pegylated interferon have different pharmacokinetic profiles, and pilot studies comparing them have yielded varying results. We compared the virologic response to 12 weeks of treatment with peginterferon alpha-2a plus ribavirin vs peginterferon alpha-2b plus ribavirin in 380 patients who were infected with HCV genotype 1 and had high viral loads. We observed no between-group differences in viral load reduction over time and no differences in the percentage of patients treated with peginterferon alpha-2a or peginterferon alpha-2b plus ribavirin who achieved early virologic response (EVR), defined as >/=2-log reduction in HCV RNA concentration or undetectable HCV RNA at 12 weeks (66%vs 63%). Serum levels of interferon were more frequently below the level of quantitation in patients treated with peginterferon alpha-2b plus ribavirin (58-68%) than in those treated with peginterferon alpha-2a plus ribavirin (1-2%). Patients treated with peginterferon alpha-2b plus ribavirin had higher rates of discontinuation for safety reasons (6%vs 1%). In conclusion, a substantial percentage of patients infected with HCV genotype 1 and high viral load can achieve EVR when treated with peginterferon and ribavirin. The 2 pegylated interferons showed comparable anti-HCV activity during the first 12 weeks of treatment when combined with the same doses of ribavirin (1000-1200 mg/day), but discontinuations for safety reasons were higher in the patients treated with peginterferon alpha-2b plus ribavirin.
Subject(s)
Antiviral Agents/therapeutic use , Hepacivirus/isolation & purification , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Polyethylene Glycols/therapeutic use , Ribavirin/therapeutic use , Drug Therapy, Combination , Female , Hepacivirus/genetics , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/virology , Humans , Interferon alpha-2 , Interferons/blood , Male , Middle Aged , RNA, Viral/blood , Recombinant Proteins , Time Factors , Viral LoadABSTRACT
Hepatitis C virus (HCV) is a common but insidious and indolent viral infection that can lead to chronic hepatitis, cirrhosis, and hepatocellular carcinoma. This article provides the advanced practice nurse with current information on prevalence, incidence, spread, and clinical course of hepatitis C. It presents a discussion of the methods of diagnosis, treatment, and management of affected patients. To date, the diagnosis of hepatitis C in the United States has been serendipitous because no surveillance and screening programs have been established. It has been estimated that approximately 4 million persons in the United States are infected with HCV, with only 30% presently diagnosed. Patients with hepatitis C must make informed choices regarding their care and treatment. As more people are diagnosed with hepatitis C, the advanced practice nurse is at the forefront of providing information about spread and diagnosis, treatment options available, and potential side effects of antiviral therapy. The decision to treat chronic HCV must be made in collaboration with other medical experts in hepatology and antiviral therapy, and it must be made with knowledge and understanding of all facets of the disease process and adverse effects of therapy.
