Side-effects of hepatitis C virus treatments

Side-effects of hepatitis C treatment are quite common, but can often be managed using adjunct medications and practical aids. Interferon side-effects may include a flu-like feeling with fevers and joint pain. These symptoms can range from mild to severe, but often lessen as treatment goes on. Conventional interferon and peginterferon produce similar side-effects.

The major side-effect of interferon is depression, and people who are prescribed this treatment should be made aware of the potential severity of the depressive symptoms that might occur. Necessary support and back-up antidepressant medication should also be discussed before treatment. Some studies suggest taking prophylactic antidepressants before or at the same time as starting interferon is an effective strategy.1 2

A recent report has suggested that peginterferon plus ribavirin can cause eye lesions and affect colour vision in co-infected individuals:3 nerve damage and other eye diseases have also been seen in people with HCV or HBV alone who are taking interferon.

In addition, interferon can cause neutropenia (low white blood cell counts, which may include a drop in CD4 T-cells) and thrombocytopenia (low platelet counts), while ribavirin can cause the blood disorder haemolytic anaemia (low red cell count). Colony stimulating factors can be used to treat neutropenia, and epoetin alfa (Eprex) can restore red blood cells.4 Co-infected people taking anti-HIV drugs such as AZT (zidovudine, Retrovir), ddI and other nucleoside reverse transcriptase inhibitors (NRTIs) may be at increased risk of blood cell deficiencies.

Some studies have found that hepatitis C treatment side-effects are more common in co-infected individuals than in people with HCV alone. Co-infected people, particularly women5, typically have higher trial drop-out rates and more often need to have their interferon or ribavirin doses reduced.6 Further, people with advanced liver disease and those with more heavily compromised immune function appear more likely to develop severe side-effects from anti-HCV therapy.7 In the APRICOT study, co-infected people with advanced liver damage were at higher risk for decompensated cirrhosis and loss of liver function, which occurred in 10% of patients.8

Concurrent treatment with ribavirin and NRTIs, in particular ddI or d4T (stavudine, Zerit), seems to increase the risk of mitochondrial toxicity, characterized by elevated lactate levels, and the rare but life-threatening conditions lactic acidosis and pancreatitis.9 Symptoms may include abdominal pain, nausea, difficulty breathing and numbness. Use of ddI was also associated with decompensated cirrhosis in the APRICOT study.

References

  1. Kraus MR et al. Prophylactic SSRI during interferon alpha re-therapy in patients with chronic hepatitis C and a history of interferon-induced depression. J Viral Hepatitis, 2005
  2. Schaefer M et al. Prevention of interferon-alpha associated depression in psychiatric risk patients with chronic hepatitis C. J Hepatol 42(6): 793-798, 2005
  3. Farel C et al. Serious ophthalmic pathology compromising vision in HCV / HIV co-infected patients treated with peginterferon alpha-2b and ribavirin. AIDS 18: 1805-1809, 2004
  4. Sulkowski MS et al. Epoetin alfa once weekly improves anemia in HIV / hepatitis C virus-coinfected patients treated with interferon / ribavirin: a randomized controlled trial. J Acquir Immune Defic Syndr 39: 504-507, 2005
  5. Bhattacharya D et al. Women experience higher rates of adverse events during hepatitis C virus therapy in HIV infection: a meta-analysis. Journal of Acquired Immune Deficiency Syndromes, online edition, 2010
  6. Bräu N et al. Safety of peginterferon alfa-2a (PEGASYS) 180 mcg weekly plus ribavirin (RBV) 800 mg daily in HIV/HCV coinfection compared to HCV monoinfection. 15th International AIDS Conference, Bangkok, abstract 3311, 2004
  7. Moreno L et al. Outcome and safety of IFN/RBV in HCV/HIV coinfected patients with advanced fibrosis. 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, abstract V-784, 2004
  8. Mauss S et al. Risk factors for hepatic decompensation in patients with HIV/HCV coinfection and liver cirrhosis during interferon-based therapy. AIDS 18: 21-25, 2004
  9. Bani-Sadr F et al. Risk factors for symptomatic mitochondrial toxicity in HIV/hepatitis C virus-coinfected patients during interferon plus ribavirin-based therapy. J Acquir Immune Defic Syndr 40: 47-52, 2005

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