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home - Liver - Hepatitis C - Hepatitis C Treatment Side Effects Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Also..

Hepatitis C Treatment Side Effects

Written by Dr Sebastian Zeki ThrombocytopeniaCan be due to interferon but very rare and usually if have cirrhosisDose reduction the best therapy Treatment:RBV dose areductionErythropoietin (EPO)- can use at any time to maintain Hb at 11-12 g/dl NeutropoeniaInterferon causes bone marrow suppression and neutropoenia but no increases in sepsis.It is worse at 24 hours post PEG-IFN injectionTreatment:.G-CSF is used usually only if teh neutropoenia is severe and other immunosuppression risks (transplant/ HIV etc) are present. Flu-like symptoms This is the most common side effect.It is most severe 48 hours after first IFN administration (persist >1 month in 1/3rd). DiabetesControl may be more difficult in IFN treated patients. PregnancyIFN can cause premature abortion.Ribavarin is teratogenic.Always advise patients to use contraception. 5-10% of patients develop one of:Graves' diseasePainless thyroiditis Hashimoto’s Neuropsychiatric problems Hepatitis C Treatment Side Effects Hair loss Reversible hair loss occurs in 20% due to telogen effluvium, as a result of IFN.Hair returns in 3-6 months. Autoimmune disease exacerbation Treatment can make known autoimmune disease worse.It is contraindicated in patients with known autoimmune hepatitis. Thyroid dysfunctionPatients often get antithyroid antibodies without clinical disease (5 to 15 % of patients). Always monitor patient TFT’s.It doesnt always resolve on cessation. Hearing loss Patients can get sudden hearing loss which doesnt resolve on discontinuation. Migraine headaches This is due to ribavarin in 2%. Respiratory tract symptomsSOB and cough are common with IFN.It rarely cause interstitial pneumonia and bronchioli-tis obliterans.If there is no anaemia and a normal CXR, just need dose reduction.Sarcoidosis can appear in association with IFN Recognition And Risk FactorsMultiple studies demonstrate that treatment with IFN-alfa plus ribavirin is associated with the development of a wide range of neuropsychiatric side effects.30 % get depression within 4-8 weeks of treatment.Other symptoms:Fatigue- most common single symptomInsomniaAppetite lossDepressed moodIrritabilityhLoss of pleasure in activitiesPain complaintsGuiltFeelings of hopelessnessBiggest risk factor for development of psych side effects is mood and anxiety symptoms prior to therapy,History of depression may not be at markedly increased risk unless they have symptoms prior to therapy.Substance abuse does not seem to be a strong predictor of neuropsychiatric side effectsTreatment And PreventionStart pharmcological therapy if at risk for a mood disturbance (SRI’s)If have psychiatric disturbance pre existing, liase with psychiatristSingle symptoms of fatigue, sleep disturbance, pain or irritability predict the later development of full major depression.If dont respond to SSRI’s, try psychostimulants such as modafinil or bupropion or mirtazipineFor insomnia, try sleep hygiene advice, non-benzodiazepine hypnotic (such as zolpidem or zopiclone) or a sleep promoting antidepressant such as trazodone,If predominant symptoms are aches and pains, we suggest a combined serotonin-norepinephrine reuptake inhibitor (SNRI) eg venlafaxine , desmethylvenlafaxine, and duloxetine For irritability-SRI or SRNI Suicide is a risk Ophthamologic disorders:Retinal hemorrhages.Cotton wool spots.Loss of color vision. Retinal artery or vein obstruction.Mild-to-moderate ischemic retinopathy. Anaemia— This is common with PEG/RBV with a mean drop of 3g/dl Hb.RBV-induced haemolysis is the most common cause- it is due to ATP deficiency in RBC’s.RBV-induced haemolysis is reversible.RBV-induced haemolysis is dose dependent.RBV can cause bone marrow hyperplasia.RBV is renally excreted so don’t use in severe renal impairment.IFN causes suppression of the normal compensatory bone marrow response. Dermatologic complications Most common is a non-specific, pruritic rash associated with flaky dry skin.Usually resolves over time but may need dose reduction.

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