THE NATIONAL
HEPATITIS C INSTITUTE
The Hepatitis C Awareness & Prevention Campaign


Serving the Hepatitis C Community

 

  • TREATMENT with Interferon and Antiviral Medications
     "It's Not for Everyone"

    Treatment Impact on Hepatic Manifestations

  • Impact of treatment on extra hepatic manifestations in patients with chronic hepatitis C.
     It is concluded that patients with chronic HCV infection reported a wide variety of rheumatological manifestations, impairing their quality of life, with discrete frequency. These results suggest that HCV infection should be considered in the differential diagnosis of rheumatological symptoms of unknown origin. 
     
  • Treatment of autoimmune and extrahepatic manifestations of HCV ...an autoimmune disorder or overlap syndromes (i.e. both autoimmune and viral hepatitis), interferon should not be given as a first intention, since revelation or exacerbation of autoimmune hepatitis has been reported with interferon....A marked prevalence of anti-HCV antibodies has also been reported in patients with sialadenitis, lichen planus and thyroiditis. Interferon may induce or worsen these immunologic diseases, but there are very few studies showing improvement of these manifestations with interferon. 
     
  • Neurovisual impairment A Frequent complication of Alpha-Interferon treatment in Chronic Viral Hepatitis
     
  • Hemolysis and Bone Marrow Suppression
     
  • Autoimmunity and extrahepatic manifestations in hepatitis C virus ...
     
  • Iron and Ribavirin In addition....hepatic iron concentration has an influence on the response to therapy for chronic hepatitis C with interferon-alfa.

    Morphine enhances hepatitis C virus (HCV) replicon expression.
     In addition, morphine compromised the anti-HCV effect of interferon alpha (IFN-alpha). Our in vitro data indicate that morphine may play an important role as a positive regulator of HCV replication in human hepatic cells and may compromise IFN-alpha therapy.

    HCV and Brain Dysfunction

  • Hepatitis C - A Medical & Psychiatric Disorder- Recommendation- It is critical for physicians and counselors to quickly recognize the pre-existing depression, or depression caused by Hepatitis C or the side effects of HCV pharmacologic therapy!

    In the study by Renault, he described psychiatric side effects of interferon fell into three categories:

    • Organic personality syndrome:
      • Irritability
      • Short temper
    • Organic affective syndrome:
      • Extreme emotional lability
      • Depression
      • Tearfulness
    • Delirium:
      • Clouding of consciousness
      • Agitation
      • Paranoia
      • Suicidal potential

    These symptoms can appear one to three months after starting interferon treatment and can improve in three to four days after decreasing interferon. The symptoms resolved when therapy was stopped. The organic syndromes were seen in patients with the highest doses of interferon; delirium occurred in patients with severe hepatitis who also had previous organic brain injury, organic brain dysfunction...

    Thyroid Dysfunction in Chronic Hepatitis C Patients Treated with Interferon/Ribavirin

    Some patients with chronic hepatitis C experience thyroid problems, and thyroid dysfunction may also be a side effect of interferon-based treatment.

    As reported in the June 2006 Journal of Viral Hepatology, researchers from Taiwan conducted a study to investigate the role of thyroid auto-antibodies in the development of thyroid dysfunction among chronic hepatitis C patients receiving interferon plus ribavirin.

    The study enrolled 95 treatment-naïve patients with normal baseline thyroid hormone levels. They were treated with 6 million units of interferon-alpha twice weekly plus 1,000-1,200 mg daily ribavirin for 24 weeks. Thyroid function, anti-thyroglobulin antibodies, and anti-peroxidase auto-antibodies were measured at enrollment, at the end of treatment, and six months after completion of therapy.

    Results

    • The percentages of thyroid auto-antibodies were 8.4% at baseline, 11.6% at the end of treatment, and 9.5% six months post-treatment.
    • 14 patients (14.7%) patients developed thyroid dysfunction by the end of treatment or the six-month post-treatment measurement.
    • Thyroid dysfunction occurred during treatment in 5 of the 8 patients (62.5%) with baseline thyroid auto-antibodies, compared with 9 of 87 patients (10.3%) without baseline thyroid auto-antibodies (P = 0.0001).
    • Among the 14 patients who developed thyroid dysfunction, 4 of 5 individuals (80.0%) with baseline thyroid auto-antibodies recovered by six months post-treatment, compared with 2 of 8 patients (25%) without baseline thyroid auto-antibodies (P < 0.05).

    Conclusion

    The authors concluded thyroid auto-antibodies, present either before or during interferon plus ribavirin combination therapy, “carry a high prediction of subsequent thyroid dysfunction. There also exists difference in the clinical manifestations of thyroid dysfunction in chronic hepatitis C patients treated with combination therapy.”

    Reference

    J F Huang, W L Chuang, C Y Dai, and others. The role of thyroid autoantibodies in the development of thyroid dysfunction in Taiwanese chronic hepatitis C patients with interferon-alpha and ribavirin combination therapy. Journal of Viral Hepatitis 13(6): 396-401. June 2006

    Extrahepatic Manifestations of Hepatitis C The question is asked, "are these related to HCV’s natural progression or have they been exasperated by treatment?"

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