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Table 11. Monitoring While on Pegylated Interferon Plus Ribavirin Combination Therapy

for Health Care Providers

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

ParameterIntervalRecommended Action/Comments
*Adapted from the VA Treatment Recommendations for Patients with Chronic Hepatitis CLink will take you to our Viral Hepatitis internet site

**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 CountWeek 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 ALTMonth 1, then every 2-3 monthsMonitor when doing other tests
Pregnancy testMonthly 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 therapyConsider 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 therapyEssential for defining on-treatment and posttreatment response
Depression screen At each routine visitFor patients screening positive, consider antidepressant and/or Mental Health referral
TSH Every 6 months before treatment and at 6 and 12 months on treatmentIf TSH becomes elevated, confirm result and consider thyroid replacement therapy
Liver biopsyRepeat 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