HCV Info Fact9 Nov 2003 Antiviral therapy has steadily improved over the last decade. The side effect profile of interferon-based therapies has remained largely unchanged. Recent data have suggested that improved adherence to combination regimens will favorable affect sustained virologic response rates. The minimal criteria recommended by the National Institutes of Health for candidates for interferon-based therapy is elevated liver enzyme levels for at least 6 months; the presence of portal fibrosis or moderate to severe liver inflammation on liver biopsy; compensated liver disease; no contraindications to treatment; patient compliance and acceptance of therapy; abstinence from alcohol; abstinence from illegal drugs. Combination interferon and ribavirin treatment is contraindicated in patients who have anemia, hemolysis, renal insufficiency, coronary artery disease, cerebral vascular disease, or gouty arthropathy, or who are unable to practice contraception. However, some of these patients may be suitable candidates for interferon monotherapy. Patients who should NOT receive antiviral treatment are those with persistently normal ALT readings; women who are, or plan to become, pregnant, or their male partners; patients with advanced cirrhosis; anyone younger than 18 years. Specific Treatment Issues for Patients on Methadone Maintenance Treatment (MMT) Sometimes there have been treatment barriers withholding or delaying available treatments for hepatitis in MMT patients and/or their rejection by liver transplant programs in some cases. On the basis of recommended guidelines of consensus conferences held in the United States, Canada, and Europe, most specialists refuse to administer antiviral HCV treatment until all illicit drug use has ceased for a period of time-usually 6 months. Some practitioners also require abstinence from methadone. A more recent guideline on HCV management from the National Institute of Diabetes and Digestion and Kidney Diseases (NIDDK) specifically states, “Patients can be successfully treated while on methadone.“ This message has been overlooked by some liver treatment specialties. Treatment is legitimately delayed in some patients because they have active psychiatric disease, an unstable family or job situation, or a medical condition needing more immediate attention. However, stable MMT alone does not preclude successful treatment. A recent prospective, study of 50 MMT patients and 50 control patients concluded that pegylated interferon and ribavirin seem reasonably safe and sufficiently effective in patients on methadone maintenance. There was a lower efficacy in methadone patients, most probably due to a lower adherence. But the end of treatment result is still close to the results of the pivotal study which led to the approval of PEG- Intron and ribavirin combination therapy. Info Facts are prepared by the HCV Committee and under the direction of Dr. Kishore. |