Hepatitis C Management

Ask The Experts

Question:

This case is a 42-year-old patient weighing 62 kg who has been an HCV carrier for 20 years, post-transfusion. He has genotype 1, RNA titer by PCR of 1,624,520 IU/mL, and normal liver function tests. He was treated with a combination therapy of pegylated interferon 100 µg and 800 mg ribavirin. After 12 weeks of therapy, the RNA test result was negative, and therapy was continued for 48 weeks. Six months after completing the 48-week regimen, he had a positive viral load of 1,829,400 IU/mL. Is there any benefit to retreating using a product from a different manufacturer?

Based on his history, this patient would fit into the category termed relapsers, defined as virologic response during therapy with return of virus after discontinuation of treatment. At the present time, no data suggest that patients who failed or relapsed after 48 weeks of one pegylated interferon will respond to another brand of pegylated interferon.

Studies have shown variable improvement in outcome with 72 weeks of therapy with pegylated interferon and ribavirin in these patients. Another option to consider is daily consensus interferon in combination with ribavirin, although this use is not FDA approved. As more studies continue to be published to address these issues, options will become clearer for these patients.