Hepatitis C Management

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A 49-year-old man with HCV, genotype 1, and a high viral load has cryoglobulinemia and a history of vasculitic rash. He had received a 9-month course of peginterferon with ribavirin in 2001, discontinued because of complications related to drug abuse. A second course of treatment this year was stopped when he did not achieve an early viral response (EVR). He did not have the rash while on treatment, but he did have a recurrence while off treatment. Is there any role for maintenance therapy with peginterferon in this setting?

Patients with vasculitis related to type II mixed cryoglobulinemia can achieve virologic and symptomatic response during anti-HCV therapy but have high rates of relapse after discontinuation of therapy. Keep in mind there are several immunomodulation therapies available for symptomatic cryoglobulinemia, and these therapies are usually administered and monitored by rheumatolgists. Consultation should be considered prior to long-term administration of interferon. It is important to emphasize that the safety and efficacy of long-term anti-HCV therapy has not been established.

For more information, see the section on managing side effects in the Hepatitis C Management monograph.

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