good adjective to describe hepatitis C virus (HCV) infection is
“tricky.” Many Americans are infected and don’t know it, and are chronic
carriers of the virus. Patients who have HCV infection are at high risk
for arthralgia, myalgias, pruritus, neuropathy, and decompensated
livers. Until recently the sole available treatment was interferon.
After the US Food and Drug Administration (FDA) approved ribavirin,
patients who took ribavirin plus interferon responded better. Now, the
FDA has approved a small selection of oral antivirals to treat hepatitis
C. Collectively, these drugs successfully induce sustained virologic
response in more than 90% of patients.
Studies showed that HCV-infected patients who have comorbid HCV-related
cirrhosis who receive double therapy (interferon and ribavirin) are at
elevated risk of bacterial infections. Recent guidelines recommend
adding a protease inhibitor (telaprevir or boceprevir, called triple
therapy) to the interferon and ribavirin regimen to increase the
likelihood of sustained virologic response. A team of European
researchers, curious about how infection rates might be affected, set
out to compare infection rates between treatments. Their study appeared in the October 2014 issue of the Journal of Hepatology.
Triple therapy was associated with a significantly higher infection rate (25%) compared to double therapy (9%). Patients who received double therapy; however, were more likely to develop respiratory tract infections (12%) than those on triple therapy (1%).
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