INTERFERON-RIBAVIRIN TREATMENT IN CHRONIC HEPATITIS C– THE LESS TALKED ABOUT ASPECTS
AbstractBackground: Combination therapy with interferon and ribavirin has become the standard of carein the treatment of Chronic Hepatitis C (CHC) infected patients. Treatment response, however, isnot 100% and is accompanied with side effects faced by the patient as well as observed inhaematologic indices. Studies are focusing on daily or high-dose induction therapy withinterferon, the titration of interferon dosing to initial viral load, higher doses of interferonthroughout treatment, and adjustment of interferon dosing to the viral responses. The safety andefficacy of these approaches have not been sufficiently established. Objectives were to see theresponse of 2 different dosage regimens, effects and side effects and to assess the efficacy and sideeffects of 2 treatment regimens of Interferon and Ribavirin in CHC. Methods: A total of 32patients with CHC at Department of Gastroenterology and Hepatology, Shaikh ZayedPostgraduate Medical Institute Lahore from June 2001 to February 2003 were included in thestudy and were divided into two groups for treatment. Group A (14 patients) received 5 MU ofinjection Interferon alpha 2 b S/C daily for 2 weeks followed by 3 MU thrice weekly for the next22 weeks. Group B (18 patients) received injection interferon alpha 2 b 3 MU S/C thrice weeklyfor 24 weeks. Ribavirin therapy was started at 1200 mg daily in 3 divided doses and later modifiedaccording to side effects. Patients were evaluated at 2, 4, 8, 12, 16, 20 and 24 weeks during thetherapy and then 24 weeks after the completion of treatment. Results: Out of 32 adult patientsincluded in the study, 18 were males and 14 females. Haemoglobin was more than 12 gm/dl infemales and more than 13 gm/dl in males, WBC count was more than 3.0109/L and Platelet countwas more than 100109/L. Twenty patients completed 6 months combination treatment, 16reported with their end of treatment HCV RNA PCR results, 8 from each group. Twelve patientswere lost to follow up. End of treatment response (ETR) in group A was 88% and 62.5% in groupB. Sustained virological response in group-A was 5/8 (62.5%) and 4/5 (50%) in group-B. Thefrequency and severity of flu like symptoms like fever, body aches, skin rash, hair loss, cough andpsychiatric symptoms were more in group A than in group B. There was no significant differencein the 2 groups for haematologic side effects. Conclusions: Treatment with 5 MU interferon dailyfor initial two weeks followed by 3 MU thrice weekly for 22 weeks is more effective than 3 MUthrice weekly for 24 weeks but with more side effects.Keywords: Hepatitis, Chronic Hepatitis C, Interferon, Ribavirin, Therapy, Side effects
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