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Table 11. Monitoring While on Pegylated Interferon Plus Ribavirin Combination Therapy*
Back to Management and Treatment of Hepatitis C Virus Infection in HIV-Infected Adults
| Parameter | Interval | Recommended Action/Comments |
|---|---|---|
*Adapted from the VA Treatment Recommendations for Patients with Chronic Hepatitis C **The pharmaceutical package insert for pegylated interferon alfa-2a (40 kD) recommends discontinuation when platelets fall below 25 x 109/L, but the pharmaceutical package insert for pegylated interferon alfa-2b (12 kD) recommends discontinuation when platelets fall below 50 x 109/L. | ||
| Hgb,Hct,WBC/diff, and Platelet Count | Week 1 or 2, and week 4, then monthly or bimonthly during therapy. Monthly intervals are recommended in patients with values below the lower limit of normal | Permanently discontinue both drugs if Hgb <8.5 g/dl, Neutrophil <0.5 x 109/L, or Platelets <25 x 109/L** |
| Serum ALT | Month 1, then every 2-3 months | Monitor when doing other tests |
| Pregnancy test | Monthly during therapy and for 6 months after completing therapy | Male patients and/or partners receiving combination therapy should use barrier contraceptives plus one other form of effective contraception throughout and for 6 months after therapy If a positive pregnancy test is confirmed, therapy should be discontinued and the outcome of the pregnancy monitored closely |
| HCV RNA (By a quantitative assay) | 12 wk on therapy | Consider discontinuing treatment for patients who remain viremic at 12 wk and who have failed to have at least a two log reduction in viral load from pretreatment level |
| HCV RNA (By a sensitive assay (minimum lower limit of detection of <50 IU/mL) | End of therapy and 6 months following the completion of therapy | Essential for defining on-treatment and posttreatment response |
| Depression screen | At each routine visit | For patients screening positive, consider antidepressant and/or Mental Health referral |
| TSH | Every 6 months before treatment and at 6 and 12 months on treatment | If TSH becomes elevated, confirm result and consider thyroid replacement therapy |
| Liver biopsy | Repeat after baseline rarely needed | |
From Management and Treatment of Hepatitis C Virus Infection in HIV-Infected Adults
Hepatitis C Resource Center Program and National Hepatitis C Program Office
September 2005
