Page 24 - The Flying Publisher Guide to Hepatitis C Treatment

24 | Hepatitis C Treatment

hypertension, supraventricular arrhythmias and myocardial
infarction) and ocular (retinal abnormalities).
Usually, but not always, these side effects reverse within a
short period after the end of therapy. Extreme caution is
however recommended in patients with preexisting chronic
obstructive pulmonary disease, diabetes mellitus prone to
ketoacidosis, severe myelosuppression, and/or coagulation
disorders (including thrombophlebitis and pulmonary
embolism). RBV may cause birth defects and/or death of the
unborn infant. Pregnancy must be avoided in female patients
and in female partners of male patients.
Recognition and effective management of AEs are critical
components of the successful treatment of CHC. Additional
measures include life style modification (hypocaloric diet,
physical exercise) in order to decrease the BMI and to prevent
weight gain. There are reports suggesting the beneficial effects
of insulin sensitizers (Metformin™- to reduce hepatic
gluconeogenesis and Pioglitazone™ -to sensitize insulin
receptors and mobilize visceral fat to subcutaneous tissues). A
series of hepatoprotective drugs and antioxidants (vitamin E,
betaine, silymarin and β-carotine) inhibit the toxic effects of free
radicals and prevent the synthesis of proinflammatory cytokines
that promote steatosis (El-Zayadi 2009). Excessive alcohol use
could reduce the likelihood of therapy response and abstinence
should be recommended before and during treatment.

Response-guided therapy (RGT)
RGT is a dynamic algorithm that involves individualized
treatment based on the on-treatment virologic response.
Basically, the more rapidly HCV RNA becomes negative during
treatment, the higher the rate of SVR.
Several types of virological responses may occur, categorized
according to their timing during treatment (Di Bisceglie 2007,
McHutchinson 2009):