Examination of Fiscal Management and the Allocation of Care Act Resources US Department of Health and Human Services: Health REsources and Services Administration
INTRODUCTION
HIV/HCV Coinfection
HCV Treatment
Response to HCV Treatment: Prognostic Factors
Liver Biopsy
Treatment Strategies
Side Effects and Strategies for Managing Them
The Week 12 Early-Stopping Rule
Treating HCV: Long-Term Benefits
Treatment of Acute HCV
Expanding Access to Treatment
Barriers and Key Issues
Conclusion
Resources
References

Support groups are also a powerful motivational tool, because patients who are at earlier points in the evaluation process share in others’ successes as they pass through milestones in the evaluation and treatment process. Patients begin to believe that good outcomes are attainable. Linking individual recovery to the notion of fighting back against a community epidemic produces a powerful synergy that often results in an upward spiral of self-esteem.67

—Litwin, Soloway, and Gourevitch
(2005)

HCV TREATMENT

Although the medical management of HCV infection is complex, it can result in good medical outcomes. As with HIV disease, treatment for HCV infection has evolved, as has management of side effects and adverse events of treatment.

Until 1989, HCV was treated with injections of interferon. Interferon is a synthetic version of a cytokine (chemical messenger) produced by white blood cells. Response to interferon monotherapy was dismal. In 1998, treatment outcomes improved significantly when interferon was combined with ribavirin, a nucleoside analog (a class of drugs used for HIV treatment). HCV treatment improved again in 2001 with FDA approval of pegylated interferon. Attaching the polyethylene glycol (PEG) molecule to interferon (a process called pegylation) keeps the drug in the bloodstream longer and makes it more effective against HCV. Replacing standard interferon with pegylated interferon has significantly improved response to HCV treatment and requires a dosing regimen of only one injection per week (Table 4). Currently, therapy with pegylated interferon plus ribavirin is the standard treatment of HCV in HIV-positive people and the only FDA-approved treatment for coinfection.

In people with HIV/HCV coinfection, the duration of HCV treatment is usually 48 weeks, regardless of HCV genotype; some clinicians are considering 18 months of treatment for coinfected people who have HCV genotype 1. The primary endpoint of HCV therapy is sustained virological response (SVR), defined as no detectable HCV RNA in the bloodstream 6 months after completion of therapy. SVR is an indication of long-term remission of HCV; some experts consider it a cure.

 

 
 
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