Page 54 - The Flying Publisher Guide to Hepatitis C Treatment

54 | Hepatitis C Treatment

3/week), 2) weekly monitoring of hemoglobin levels, and 3) use
of high erythropoietin doses to treat anemia (Bruchfeld 2006).

Patients with psychiatric comorbidities
A prevalence of 60% psychiatric comorbidities has been reported
in patients with CHC. On the other side, neuropsychiatric side
effects occur in up to 50% of patients receiving treatment with
PegIFN/RBV, the commonest being depression. Prospective
clinical trials suggest that patients with HCV infection and
psychiatric comorbidities can be safely treated with interferon-
based antiviral regimens by both hepatologists and mental
health professionals as part of a multidisciplinary team (Knott
2006). An expert psychiatric assessment is required before the
decision about the management of HCV infection in this group of
patients. Through close collaboration between hepatologist and
psychiatrist, a significant proportion of patients with CHC and
well controlled psychiatric comorbidity can safely and
effectively receive antiviral treatment.

Patients with inherited anemias
CHC is common in patients with thalassemia major or sickle cell
disease, as a result of regular or intermittent red blood
transfusions. In addition to HCV injury, progression of liver
fibrosis is influenced by the degree of hepatic iron overload, with
high rates of cirrhosis and hepatocellular carcinoma (Angelucci
2002). With PegIFN/RBV combination, SVR has been reported in
40-70% of patients with thalassemia. Patients with thalassemia
major are at increased risk of AEs of interferon and careful
monitoring for side effects, iron chelation (with liver iron
maintained between 2-7 mg/g dry weight), and regular
transfusions may be necessary. These patients should be
managed preferably by a hepatologist and a hematologist, in a
joint clinic.