Note: ALT, alanine aminotransferase; HCV, hepatitis C virus; IFN, interferon; PEG IFN, pegylated interferon; IU, international units (1 IU/mL is equivalent to ~2.5 copies/mL).
Ribavirin is administered orally bid. Side effects: nausea, hemolytic anemia, MI, pneuomnitis, dyspnea, infiltrates, teratogenic. Females patients should not become pregnant when taking Ribavirin, until 6 months after cessation of therapy.
Protease Inhibitors: Effective in genotype I infections. Given with peginterferon and ribavirin.
Boceprevir 800 mg (200 mg x 4 tab) tid, q8hr with food. Treatment is initiated with a 4 week lead-in period of peginterferon and ribavirin alone; the tripel therapy with boceprevir begins at week 5. If a negative HCV PCR RNA is achieved at week 8 and week 12, treatments can cease at 28 weeks. Response guided treatment (RGT) continues depending on whether the patient is below 100 IUs of viral load measurement at specific intervals. Ideally patients complete treatment at 36 weeks, but continue with peginterferon and ribavirin for a total of 48 weeks. Null responders go on for a total of 44 weeks. Any time the viral-load is above 100 IU/mL the treatment is discontinued.
Telaprevir, 750 mg (375 mg x 2 tab) tid, q8hrs with high-fat, 20 gm snack. All three meds are given upfront (telaprevir, peginterferon, and ribavirin) x 12 weeks. Depending on response the treatment can end as early as 24 weeks or may continue for upto 36 wks. Pts with cirrhosis benefit from a full 48 week course. For null responder triple therapy for 12 weeks, followed by 36 weeks of peginterferon and ribavirin alone. If viral load is nondetected at 4 and 12 weeks, d/c telaprevir and continue peginterferon and ribavirin for a total response-week duration 24 weeks. If viral load is detectable, but below 1000 IU/mL at wk 4 and 12, continue the treatment to 12, and order an addl 36 wks of dual therapy with peginterferon and ribavirin for a total of 48 wks. If at any time the viral load goes above 1000 IU/mL, at week 4, 12, or 24, discontinue therapy.
Medications contraindicated with PIs:
Simvastatin, St, John's wort, sildenafil
Caution with amlodipine, clarithromycin, methadone, zolpidem.