Initial treatments of an HCV infection for patients that have chronic hepatitis C include interferon, ribavirin, peginterferon, or any HCV direct-acting antiviral (DAA) agent. Any of these treatments could be investigational, experimental, or US Food and Drug Administration (FDA) approved.
The amount of evidence available to help inform the public of the best regimen for each individual patient and the dosage recommendations vary. Also, recommendations are given by physicians for those who may be in a different group (genotype).
According to Hep C Treatment Guidelines:
“Recommended regimens are those that are favored for most patients in a given group, based on optimal efficacy, favorable tolerability and toxicity profiles, and treatment duration. Alternative regimens are those that are effective but, relative to recommended regimens, have potential disadvantages, limitations for use in certain patient populations, or less supporting data than recommended regimens. In certain situations, an alternative regimen may be an optimal regimen for an individual patient.”
Simplification of a treatment plan or regimen is listed in order of evidence. There are many regimens that are recommended at the same level and listed in alphabetical order. Regimen choice for specific treatments should be determined based on patient-specific data, which includes drug-interactions and type of hep C. Patients receiving antiviral therapy require careful pre-treatment assessment for comorbidities that has the potential to influence treatment response. All patients infected with the HCV virus should be under close monitoring during their course of treatment, particularly those who may suffer from anemia. If Ribavirin is included in the regimen, patients are more like to become anemic during the treatment process.
It is rare for genotype tests to indicate mixed infections, and treatment for mixed genotypes is sparse, but should always be considered. When the correct combo of treatment is unclear, an expert should always be sought out to help with the course of treatment for the patient.
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