Hepatitis - Hepatitis C

Overall, the significant side effects of the combination treatment include flu-like symptoms, blood disorders (e.g., hemolytic anemia and low white blood cell counts), and psychologic and neurologic symptoms (particularly depression). Side effects from the combination result in treatment discontinuation in 10% to 14% of patients. The most frequent reason cited in the US is depression. Of note, combination of both drugs poses a very high risk for birth defects in children whose mothers used the drugs while pregnant.

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Determining Treatment Success. Physicians gauge treatment success and approaches based on the patient?s response to the treatments:

Early Response. These are patients who respond to the drug right away. This means that their viral count drops very rapidly within the first few weeks of treatment and is still undetectable at 12 weeks. (One difficulty in deciding when to stop treatment even in responders is the inability to predict at 12 weeks which of these patients will relapse and which ones will have sustained response.)
Sustained Response. Patients who are free of the virus longer than six months are considered to be sustained responders. The overall sustained response rates with the current standard combination of pegylated interferon and ribavirin is over 50%, with certain factors predicting higher or lower response rates.
Relapse. In relapse, the virus comes back again and requires retreatment. This occurs most likely because of the development of mutant strains that may be resistant to the drugs used or because the original dose was too low.
Nonresponse. Patients are considered to be nonresponders if the virus is still detectable 12 weeks after interferon alone or 24 weeks of combination therapy. Retreating these patients has achieved only a 15% response. Those who achieved a-called breakthrough at some point in the initial treatment may be more likely to response. (During a breakthrough there is a temporary reduction in liver enzymes or disappearance of the virus.) Alfacon-1 (Infergen) may be beneficial for some nonresponding patients. Patients should also ask their physician about any clinical trials that might be appropriate.

People at Risk for Poor Response to Combination Treatment. The following patients have a higher chance for a lower response to combination treatment with interferon and ribavirin:

People who are at high risk in the first place for aggressive hepatitis C.
Having a high viral count.
Having a specific genetic type of the virus affects the response to treatment. Those with genotypes 2 or 3 who are given the current standard treatment (pegylated interferon plus ribavirin) can now achieve a sustained response of over 80%. Unfortunately, the response is lower in those with genotype 1. In one 2003 study, the sustained response rates in patients with genotype 1 were 39% in Caucasian patients and 26% in African Americans (which were the highest response rates reported at that time for this latter group). Young people with type 1 have a much higher response rate than older patients.
Being African American also poses a risk for poor response. African Americans are less responsive to treatment than Caucasians and Asians. The reasons for this are unclear.