Re: Hepatitis C, proper treatment

Posted By Jere L. Hough on March 15, 1998 at 00:57:12:

In Reply to: Hepatitis C, proper treatment posted by Jere L. Hough on March 15, 1998 at 00:40:36:







:

: I have several questions re: Hepatitis C treatment with interferon alpha 2b 3mu x 3/wk:

: 1.  How long after a patient goes to undetectable HCV RNA by PCR should Interferon alpha 2b tratment ordinarily be continued in order to achieve a maximum chance to sustain a long term response?

: 2.  Assuming normal patient tolerance to Interferon injections, under what circumstances would it be medically sound practice to discontinue IFN therapy at the exact moment in time when a patient returns a negative HCV PCR?

: Thank you for your answer to the above,

: Jere



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Dear Jere:

I really appreciated your questions about the therapy of hepatitis C infections.  They are extremely important.  You ask two questions.  The first asks how long should interferon alpha-2b be continued once a patient receiving interferon no longer has detectable HCV RNA by PCR in his serum (blood test).  Typically patients on interferon are evaluated closely 12 weeks after interferon is started to determine their response.  If patients have no detectable HCV RNA (by PCR) at 12 weeks they are then termed a responder and, if they are tolerating the drug, they would typically receive another 36 weeks of interferon for a total of 48 weeks.  The 12 week visit is a critical one because it is usually at this visit that a decision is made to stop or continue interferon.

Your second question asks if  it would ever make sense to stop interferon at the exact moment that a patient returns a negative HCV RNA.  Based on what Ive said above, it typically would not make sense to stop interferon with an initial negative HCV RNA in blood.  We would check the HCV RNA in serum (blood) at 12 weeks and if it was undetectable and the patient was tolerating drug, we would anticipate another 36 weeks or roughly 9 months of therapy.  

It may be that you are concerned about a particular situation (yourself, family, a friend).  In that case, it might be useful to know more specific information.  At Henry Ford, we have a very active Liver Unit with very active clinical and research interests in hepatitis C.  We would certainly invite you to contact or visit us.  The direct number to our liver clinic is: [phone].

This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.

I hope this information is helpful to you.

Dear Doctor:  Thank you very much for your helpful information.  You seem to indicate that one is classified as a "responder" to interferon if one returns an undetectable viremia by PCR at 12 weeks, or 3 months.  Would not one still be classified as a "responder" if one went negative for viremia at 6 months, or 12 months or even 18 months?  
Would not returning a negative PCR for the first time at 12 months cause one to be classified as a "responder" and warrant further interferon therapy?  
Thank you for any further clarification.