184 VII. Approach to Hepatic Infections
A. Acute HCV Infection 1. Symptomatic patients. A waiting period of 12 weeks has been suggested as patients may have spontaneous recovery. If no spontaneous recovery is observed, suggested treatment includes: 1. Genotype 1 and 4 and or/ HIV coinfection: peginterferon alfa-2b 1.5 mcg/kg or peginterferon alfa-2a 180 mcg weekly for 24 to 48 weeks. 2. Genotype 2 and 3 without HIV coinfection: same as above but 24 weeks. 3. Asymptomatic patients. Treated the same as symptomatic patients except there is no 12-week waiting period. B. Chronic HCV Infection 1. Genotype 1a or 1b. [Peginterferon alfa-2a 180 mcg SQ weekly with ribavirin 1000 mg (less than or equal to 75 kg of body weight) or 1200 mg (greater than or equal to 75 kg) or peginterferon alfa-2b 1.5 mcg/kg SQ weekly with ribavirin 800 mg (less than or equal to 65 kg) or 1000 mg (greater than or equal to 65–85 kg) or 1200 mg (greater than or equal to 85 kg)] plus [telaprevir 750 mg three times a day or boceprevir 800 mg three time a day]. Duration of treatment ranging between 24 and 48 weeks to be determined with response-guided therapy depending on early viral kinetics. Telaprevir is always used for 12 weeks and boceprevir from 24 to 48 weeks. 2. Genotype 4. Peginterferon alfa-2a 180 mcg SQ weekly with ribavirin 1000 mg (less than or equal to 75 kg) or 1200 mg (greater than or equal to 75 kg) for 48 weeks or peginterferon alfa-2b 1.5 mcg/kg SQ weekly with ribavirin 800 mg (less than or equal to 65 kg) or 1000 mg (greater than or equal to 65–85 kg) or 1200 mg (greater than or equal to 85 kg) for 48 weeks. Some patients may need therapy extended to 72 weeks. 3. Genotype 2 and 3. Peginterferon alfa-2b 1.5 mcg/kg or peginterferon alfa-2a 180 mcg SQ weekly with ribavirin 800 mg for 24 weeks. 4. Any genotype with HIV coinfection. Peginterferon alfa-2a 180 mcg SQ weekly with ribavirin 1000 mg (less than or equal to 75 kg) or 1200 mg (greater than or equal to 75 kg) for 48 weeks or peginterferon alfa-2b 1.5 mcg/kg SQ weekly with ribavirin 800 mg (less than or equal to 65 kg) or 1000 mg (greater than or equal to 65–85 kg) or 1200 mg (greater than or equal to 85 kg) for 48 weeks. Some patients may need therapy extended to 72 weeks. bibliography Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009 Apr;49(4):1335–1374. Lauder GM, Walker BD. Hepatitis C virus infection. N Engl J Med. 2001 Jul 5;345(1):41–52. Maheshwari A, Thuluvath PJ. Management of acute hepatitis C. Clin Liver Dis. 2010 Feb;14(1):169–176.
Nash KL, Bentley I, Hirschfield GM. Managing hepatitis C virus infection. BMJ. 2009 Jun 26;338:37–42.