Antiviral treatment goals
The incidence of cirrhosis in patients with hepatitis C virus (HCV) infection is 5%-25% after 25-30 years, the incidence of liver failure in patients with HCV-related cirrhosis is 30% after 10 years, and the annual incidence of hepatocellular carcinoma is 1%-3%. Effective antiviral therapy can improve long-term survival and quality of life of patients. Therefore, the long-term goals of antiviral therapy are to reduce the incidence of HCV-related cirrhosis, liver failure and hepatocellular carcinoma, to reduce the incidence of HCV-related death and to improve the quality of life of patients.
Indications and contraindications of antiviral therapy
(A) Indications
(1) For chronic hepatitis C, HCV RNA-positive patients without contraindications to treatment should be considered for antiviral therapy.
(2) For hepatitis C cirrhosis, the indications for antiviral therapy are mainly differentiated according to liver function compensation: treatment is strongly recommended for patients with Child-Pugh score A (early cirrhosis), patients with Child-Pugh score B (intermediate cirrhosis), and patients with Child-Pugh score C (advanced cirrhosis) are not recommended for treatment. Patients who do not meet the scoring requirements can be treated by actively improving liver function first, and if liver function improves to meet the antiviral indications, antiviral therapy can be administered.
(II) Contraindications
1. Absolute contraindications: advanced cirrhosis (liver function Child-Pugh grade C); expectation; uncontrolled depressive psychiatric disease; coexisting serious physical diseases, such as severe hypertension, heart failure, coronary artery atherosclerotic heart pile disease; uncontrolled autoimmune diseases; allergy to antiviral therapy; patients with granulocyte count, platelet count and hematocrit levels that cannot Tolerate anti-disease treatment.
2. Relative contraindications: mid-stage cirrhosis (liver function Child-Pugh grade B); thyroid disease; organ transplantation; psychiatric disease that is now under control.
Anti-viral treatment regimen
Pegylated interferon (Peg-IFN) in combination with ribavirin (RBV) is the current standard antiviral regimen for chronic hepatitis C. Sustained virologic response is achieved in approximately 65% of patients.
Adverse effects during antiviral therapy and management
During the course of interferon antiviral therapy, some of these patients may develop elevated ALT and a few patients may even develop jaundice. Additional interferon adverse reactions are as follows.
(1) Influenza-like syndrome: manifested as fever, chills, headache, muscle aches and weakness, etc. Interferon may be injected at bedtime or antipyretic and analgesic drugs may be taken at the same time as interferon injection. With the progress of treatment, such symptoms can gradually reduce or disappear.
(2) Transient myelosuppression: mainly manifested as peripheral blood leukocyte (neutrophil) and platelet reduction, can be treated with blood cell promotion, if necessary, reduce the amount of interferon or discontinue the drug.
(3) Psychiatric abnormalities: can be manifested as depression, paranoia, severe anxiety and other psychiatric symptoms, the drug should be discontinued if the symptoms are severe.
(4) autoimmune diseases: interferon can induce the production of autoantibodies, in most cases no obvious clinical manifestations, only a small number of patients appear thyroid disease (hypothyroidism or hyperthyroidism), diabetes mellitus, etc., serious cases should be discontinued.
(5) Other rare adverse reactions: including renal damage (interstitial nephritis, nephrotic syndrome and acute renal failure, etc.), cardiovascular complications (arrhythmia, ischemic heart disease and cardiomyopathy, etc.), retinopathy, hearing loss and interstitial pneumonia, etc.
During the course of ribavirin combined with interferon antiviral therapy, about 1/3 of patients have different degrees of anemia, mainly due to the destruction of erythrocytes caused by ribavirin, and erythropoietin should be added if necessary, and the drug should be discontinued in severe cases.
Indicators that should be monitored during anti-hepatitis C virus treatment
Blood routine, liver function, hepatitis C RNA, blood glucose, thyroid function, autoimmune antibodies, urine routine and mental status, etc.