Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatic fibrosis worldwide. Up to 85% of individuals infected with HCV develop chronic infection, which can progress to cirrhosis and hepatocellular carcinoma. The primary goal in the treatment of HCV infection is to reduce the mortality by preventing liver-related deaths associated with the development of hepatocellular carcinoma and decompensated cirrhosis. Pegylated interferons together with ribavirin are currently the standard of care for patients with chronic hepatitis. Here, I discuss the goals of treatment, indication and treatment of chronic hepatitis C.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Hepatitis C, Chronic/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2a/*therapeutic use ; Interferon Alfa-2b/*therapeutic use ; Polyethylene Glycols/*therapeutic use ; Ribavirin/*therapeutic use

Chronic hepatitis B (CHB) is a serious health problem in Korea. The natural history of chronic HBV infection has been divided into 4 phases: immune tolerance, immune clearance, inactive HBsAg carrier state and reactivation. During the phases of immune tolerance and inactive HBsAg carrier state, no treatment is required. Patients in the immune clearance or reactivation phases are candidates for therapy. In the last years, treatment effects of CHB have considerably improved. Several agents are currently approved for the treatment of CHB: interferon alpha, pegylated interferon alpha, lamivudine, adefovir, entecavir, telbivudine and clevudine in Korea. The treatment recommendations from the 2004 Korean Association for the Study of the Liver guideline on the management of CHB have been updated to incorporate new therapeutic options. What is uncertain is which agent or combination of agents is most effective, how long therapy should last, and which criteria should be used to start, continue, switch or stop therapy. Issues for consideration include efficacy, safety and incidences of resistance, and method of administration of antiviral therapy in treatment-naive patients.
Adenine/analogs & derivatives/therapeutic use ; Antiviral Agents/*therapeutic use ; Arabinofuranosyluracil/analogs & derivatives/therapeutic use ; Guanine/analogs & derivatives/therapeutic use ; Hepatitis B, Chronic/*drug therapy ; Humans ; Interferon Alfa-2a/therapeutic use ; Interferon Alfa-2b/therapeutic use ; Korea ; Lamivudine/therapeutic use ; Phosphonic Acids/therapeutic use ; Polyethylene Glycols/therapeutic use ; Practice Guidelines as Topic

No abstract available.
Antiviral Agents/*administration & dosage/therapeutic use ; Drug Therapy, Combination ; Genotype ; Hepacivirus/genetics ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2a/administration & dosage/therapeutic use ; Interferon Alfa-2b/administration & dosage/therapeutic use ; Polyethylene Glycols/administration & dosage/therapeutic use ; Ribavirin/administration & dosage/therapeutic use ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: The treatment response to interferon could differ with mutations in the interferon-sensitivity-determining region (ISDR) in patients infected with hepatitis C virus (HCV) genotype-1b (HCV-Ib). We examined the pattern of ISDR mutations and analyzed whether the number of amino acid substitutions influences the treatment response to peginterferon plus ribavirin in chronic hepatitis or cirrhotic patients infected with HCV-Ib. METHODS: The study population comprised 52 patients who visited Seoul Asan Medical Center and Seoul National University Bundang Hospital from January 2006 to December 2008 and who received peginterferon alpha-2a (n=37) or -2b (n=15) plus ribavirin, and whose serum was stored. We analyzed the early virologic response, end-of-treatment response, and sustained virologic response (SVR), and examined the ISDR using direct sequencing. RESULTS: The proportions of patients with ISDR mutation types of wild (0 mutations), intermediate (1-3 mutations), and mutant (> or =4 mutations) were 50.0%, 42.3%, and 7.7%, respectively, and the corresponding SVR rates were 63%, 50%, and 67% (p>0.05). The SVR rates were 59.4% and 50.0% in patients with <2 and > or =2 mutations, respectively (p>0.05). On univariate analysis, age was the only predictive factor for SVR (p=0.016). The pretreatment HCV RNA titer tended to be lower in those with SVR, but without statistical significance (p=0.069). CONCLUSIONS: The frequency of ISDR mutations was low in our cohort of Korean patients infected with HCV-Ib. Therefore, ISDR mutations might not contribute to the response to treatment with peginterferon plus ribavirin.
Adult ; Aged ; Amino Acid Sequence ; Antiviral Agents/*therapeutic use ; Drug Resistance, Viral/genetics ; Drug Therapy, Combination ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*drug therapy/virology ; Humans ; Interferon Alfa-2a/*therapeutic use ; Interferon Alfa-2b/*therapeutic use ; Male ; Middle Aged ; Molecular Sequence Data ; *Mutation ; Polyethylene Glycols/*therapeutic use ; Republic of Korea ; Ribavirin/therapeutic use

BACKGROUND/AIMS: Various predictive factors for peginterferon alpha and ribavirin therapy in chronic hepatitis C have been reported, but the effect of adherence to therapy has not been established. We investigated how adherence affects the sustained virologic response (SVR). METHODS: We analyzed 92 chronic hepatitis C patients receiving peginterferon alpha and ribavirin combination therapy. Patients were first identified as having either genotype 1 or genotype non-1 infection and then categorized into three groups according to their adherence to the treatment protocol: (1) patients who received > or =80% of the recommended dosage of both peginterferon alpha and ribavirin for > or =80% of the intended duration of therapy, (2) patients who received <60% of the recommended dosage of both peginterferon alpha and ribavirin for <60% of the intended duration of therapy, and (3) patients who were not included in either group 1 or 2. RESULTS: The rates of early virologic response, end of treatment response, and SVR differed significantly with the degree of adherence to the treatment. The SVRs of genotype 1 patients were 86.7%, 26.7%, and 66.7% in groups 1, 2, and 3, respectively (P=0.003), and those of genotype non-1 were 100%, 16.7%, and 88.9%, respectively (P<0.001). CONCLUSIONS: Adherence to therapy is a key factor in achieving an SVR. Supportive strategies to improve adherence will increase overall SVR rates.
Adult ; Aged ; Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2a/*therapeutic use ; Interferon Alfa-2b/*therapeutic use ; Male ; Middle Aged ; *Patient Compliance ; Polyethylene Glycols/*therapeutic use ; RNA, Viral/analysis ; Ribavirin/*therapeutic use ; Treatment Outcome

BACKGROUND/AIMS: Pegylated interferon plus ribavirin combination therapy has been the standard of therapy for patients with chronic hepatitis C. Although previous studies have reported long term durability after the sustained virologic response (SVR) with standard therapy for chronic hepatitis C, it is still unclear in Korea. The aim of this study was to evaluate the relapse rate and related factors after SVR to pegylated interferon therapy in Korean patients with chronic hepatitis C. METHODS: A total of 119 chronic hepatitis C patients were treated with pegylated interferon plus ribavirin, and 73 patients achieved SVR (61.3%). Among 73 patients who achieved SVR, 68 patients (genotype 1, n=40; genotype non-1, n=28) were evaluated for virological response after SVR. RESULTS: SVR rate in genotype 1 and genotype non-1 were 52.5%, and 65.1%, respectively. Relapse after SVR occurred in 5 patients (7.4%) with genotype 1, and the median time to relapse from SVR was 10 months. Univariate analysis revealed that the dose reduction of pegylated interferon (p=0.005) and cirrhosis (p=0.03) were significantly associated with relapse. CONCLUSIONS: These results suggested that the relapse could occur even after SVR achievement in Korean patients with chronic hepatitis C, and the dose reduction of pegylated interferon during treatment or having cirrhosis may increased the risk for relapse.
Adult ; Aged ; Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon Alfa-2a/*therapeutic use ; Interferon Alfa-2b/*therapeutic use ; Liver Cirrhosis/complications ; Logistic Models ; Male ; Middle Aged ; Polyethylene Glycols/*therapeutic use ; RNA, Viral/blood ; Recurrence ; Ribavirin/*therapeutic use ; Risk Factors

BACKGROUND/AIMS: The combination therapy of peginterferon (PEG-IFN) and ribavirin is the standard treatment for hepatitis C virus (HCV) infection. However, few trials have involved patients with cirrhosis. The purpose of this study was to elucidate the efficacy and safety of treatment with PEG-IFN and ribavirin in patients with cirrhosis associated with HCV infection. METHOD: A total of 65 patients were treated with PEG-IFN alpha-2a/ribavirin (n=32) or PEG-IFN alpha-2b/ribavirin (n=33). PEG-IFN alpha-2a and PEG-IFN alpha-2b were administered at doses of 180 microg/week and 1.5 microg/kg/week, respectively, and ribavirin was administered orally at doses of 800-200 mg. Patients with HCV genotype 1 and genotype non-1 were treated for 48 and 24 weeks, respectively. The treatment response was assessed based on the sustained virologic response (SVR). RESULTS: The early virologic response (EVR), end-of-treatment response (ETR), and SVR were 70.0%, 52.0%, and 24.0%, respectively, in genotype 1 (n=50). In genotype non-1 (n=15), the ETR was 53.3% and the SVR was 33.3%. The overall SVR did not differ with genotype (1 vs non-1, 24.0% vs. 33.3%; P=0.471) or between decompensated cirrhosis and compensated cirrhosis (20.0% vs. 27.3%, P=0.630). Ten patients developed cirrhotic complications during the treatment, and 11 stopped treatment due to treatment-related adverse events. CONCLUSION: The combination therapy of PEG-IFN and ribavirin exhibited a low efficacy in cirrhotic patients with HCV infection and was associated with frequent serious complications. However, with careful management of complications, the therapy may have a considerable efficacy in some patients with cirrhosis and HCV infection.
Aged ; Antiviral Agents/adverse effects/*therapeutic use ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon Alfa-2a/adverse effects/*therapeutic use ; Interferon Alfa-2b/adverse effects/*therapeutic use ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Neutropenia/etiology ; Platelet Count ; Polyethylene Glycols/adverse effects/*therapeutic use ; RNA, Viral/blood ; Retrospective Studies ; Ribavirin/adverse effects/*therapeutic use ; Severity of Illness Index ; Treatment Outcome

Combined pegylated interferon and ribavirin therapy for chronic hepatitis C infection cause a wide range of side effects, including flu-like syndrome, hematological abnormalities, cardiovascular symptoms, gastrointestinal symptoms, pulmonary dysfunction, depression, and retinopathy. Interferon-alpha has been shown to be related to the development of various autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, autoimmune thyroid disease, and type 1 diabetes mellitus (DM). Type 1 DM and thyroid disease respectively develop in 0.08~2.61% and 10~15% of patients treated with combined interferon-alpha and ribavirin for chronic hepatitis C. The coexistence of type 1 DM and autoimmune thyroiditis was rarely reported. We report a case of a 33-year-old female patient with chronic hepatitis C who simultaneously developed diabetic ketoacidosis and autoimmune thyroiditis after treatment with pegylated interferon-alpha 2b and ribavirin.
Adult ; Antiviral Agents/*adverse effects/therapeutic use ; Diabetic Ketoacidosis/drug therapy/*etiology ; Drug Therapy, Combination ; Female ; Hepatitis C, Chronic/*drug therapy ; Humans ; Insulin/therapeutic use ; Interferon Alfa-2b/*adverse effects/therapeutic use ; Polyethylene Glycols/*adverse effects/therapeutic use ; Ribavirin/*adverse effects/therapeutic use ; Thyroiditis, Autoimmune/drug therapy/*etiology ; Thyroxine/therapeutic use

Vogt-Koyanagi-Harada (VKH) disease is a multisystem syndrome characterized by ocular (uveitis and retinal detachment), neurological (headache, tinnitus, and meningitis), and integumentary (vitiligo, alopecia, and poliosis) involvement. Although the pathogenesis of VKH disease is not well understood, an autoimmune T-cell response to a melanocyte-associated antigen is considered to be a cause of VKH disease. The complex immunological response to interferon and ribavirin may induce or exacerbate the autoimmune condition; however, VKH disease is a very rare complication associated with interferon therapy in chronic hepatitis C. We report a case of VKH disease occurring during pegylated interferon-alpha2b and ribavirin combination therapy for chronic hepatitis C.
Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/*adverse effects/therapeutic use ; Drug Therapy, Combination ; Female ; Fluorescein Angiography ; Hepatitis C, Chronic/*drug therapy ; Humans ; Interferon Alfa-2b/*adverse effects/therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Polyethylene Glycols/*adverse effects/therapeutic use ; Prednisolone/therapeutic use ; Ribavirin/*adverse effects/therapeutic use ; Tomography, X-Ray Computed ; Uveomeningoencephalitic Syndrome/*diagnosis/drug therapy/etiology

Combination therapy of pegylated interferon alpha and ribavirin has been associated with various adverse effects, but sudden-onset hearing loss is uncommon. We report a 60-year-old male patient who developed sudden-onset hearing loss during combination therapy with pegylated interferon alpha and ribavirin for chronic hepatitis C. This patient had been diagnosed with chronic hepatitis C (genotype Ib) and early-stage liver cirrhosis 3 years previously, and had been treated with conventional interferon-alpha and ribavirin for 12 months. However, 6 months from the end of the treatment course the patient relapsed and received combination retreatment with pegylated interferon alpha-2b and ribavirin. He developed sudden-onset right-side hearing loss and tinnitus 42 weeks after the start of this retreatment. Pure-tone audiometry revealed a right-side hearing loss of 60~90dB. The patient consequently immediately discontinued the pegylated interferon therapy and was given prednisone 60 mg/day for 10 days, after which the hearing loss had almost completely recovered.
Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/*adverse effects/therapeutic use ; Audiometry, Pure-Tone ; Drug Therapy, Combination ; Hearing Loss, Sudden/chemically induced/*diagnosis ; Hepatitis C, Chronic/diagnosis/*drug therapy ; Humans ; Interferon Alfa-2b/*adverse effects/therapeutic use ; Liver Cirrhosis/diagnosis ; Male ; Middle Aged ; Polyethylene Glycols/*adverse effects/therapeutic use ; Prednisone/therapeutic use ; Ribavirin/*adverse effects/therapeutic use