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Antiviral Agents Used in the Treatment of Hepatitis C
Agent Recommended Dose Adverse Effects
PegIFN alfa-2a (Pegasys™)

180 mcg subcutaneously once weekly[1]

Serious adverse events: <1%[2]

Common adverse events: 99% of patients experience at least one of the following[2]

  • Psychiatric reactions, including depression, insomnia, irritability, anxiety
  • Flu-like symptoms such as fatigue, pyrexia, myalgia, headache, and rigors
  • Anorexia
  • Nausea and vomiting
  • Diarrhea
  • Arthralgias
  • Injection site reactions
  • Alopecia
  • Pruritus
PegIFN alfa-2b (PEG-Intron™)

1.5 mc / kg SC once weekly[1]

Serious adverse events: <1%[3]

Common adverse events: 50% of patients have at least one of the following[3]

  • Injection site reaction
  • Mood instability and depression
  • Nausea
  • Fatigue/asthenia
  • Headache
  • Rigors and fevers
  • Myalgia
Ribavirin
(Rebetol™, Ribasphere™, Copegus™, RibaPak™)

Genotype 1
1,000 mg (if ≤ 75 kg) or 1,200 mg (if > 75 kg) PO daily divided into two doses[1]


Genotype 2 & 3
800 PO daily in two divided doses[1]

Ribavirin is teratogenic and may cause birth defects and/or death of the exposed fetus.

Serious adverse events:[4]

Common adverse events: [4]

  • Fatigue/asthenia
  • Fever
  • Myalgias
  • Headaches
Sofosbuvir (Sovaldi™)

400 mg orally daily

Common adverse events: 20%[5]

Simeprevir (Olysio™)

150 mg orally daily

Common adverse events: 20%[6]

Boceprevir [BOC] (Victrelis™)

800 mg (4 × 200 mg capsules) PO every 7 – 9h with food in combination with PegIFN – RBV following a 4-week lead-in with PegIFN – RBV [1]

No longer recommended given the safer profile of newer protease inhibitors

Serious adverse events:[7]

Common adverse events:[7]

  • Fatigue
  • Anemia
  • Nausea
  • Headache
  • Dysgeusia
Telaprevir [TVR] (Incivek™)

750 mg (2 × 375 mg tablets) PO every 7 – 9 h with food (20 grams fat) for 12 weeks, plus PegIFN – RBV 24 or 48 weeks [1]

No longer recommended given the safer profile of newer protease inhibitors

Serious adverse events:[8]

Common adverse events: [8]





Antiviral Medications

There are three types of treatment groups:

  1. Interferon (IFN)
  2. Nucleoside analogs
  3. Nucleotide analogs

First Line agents

Entecavir (ETV)
  • An anti-HBV nucleoside analog
  • A 94% clearance rate after 5 years of treatment is observed in HBeAg positive patients.[9]
  • A 90% clearance rate after 48 weeks of treatment is observed in HBeAg negative patients.[10]
  • A necroinflammation improvement of 96% and fibrosis improvement of 88% is seen after a treatment for 6 years.[9]
Tenofovir (TDF)
  • An anti-HBV nucleotide analog
  • A 68% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg positive patients.[11]
  • A 84% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg negative patients.
Interferons
  • Antiviral and antiproliferative glycoprotein.
  • No antiviral resistance have been noted
  • Best results noted with genotype A or B who are HBeAg positive.

Second line agents

Telbivudine (LDT)
  • Nucleoside analog
  • Worse resistance than first line agents and not indicated if resistance to other nucleoside analogs are noted.
Adefovir (ADV)
  • Nucleotide analog
  • Worse resistance than first line agents
  • Used in cases of nucleotide analog resistance.
Lamivudine

Pathogenesis

Treatment

When listeric meningitis occurs, the overall mortality may reach 70%; from septicemia 50%, from perinatal/neonatal infections greater than 80%. In infections during pregnancy, the mother usually survives. Reports of successful treatment with parenteral penicillin or ampicillin exist. Trimethoprim-sulfamethoxazole has been shown effective in patients allergic to penicillin.

Bacteriophage treatments have been developed by several companies. EBI Food Safety and Intralytix both have products suitable for treatment of the bacteria. The FDA of the United States approved a cocktail of six bacteriophages from Intralytix, and a one type phage product from EBI Food Safety designed to kill the bacteria L. monocytogenes. Uses would potentially include spraying it on fruits and ready-to-eat meat such as sliced ham and turkey.

Table

Disease Findings
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  1. 1.0 1.1 1.2 1.3 1.4 1.5 Yee HS, Chang MF, Pocha C, Lim J, Ross D, Morgan TR; et al. (2012). "Update on the management and treatment of hepatitis C virus infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office". Am J Gastroenterol. 107 (5): 669–89, quiz 690. doi:10.1038/ajg.2012.48. PMID 22525303.
  2. 2.0 2.1 [| PEGASYS Prescribing Information. Genentech, Inc. 2013.]
  3. 3.0 3.1 [| PEGINTRON Prescribing Information. Merck & Co., Inc. 2013.]
  4. 4.0 4.1 [| COPEGUS Prescribing Information. Genentech, Inc. 2013.]
  5. [| SOVALDI Prescribing Information. Gilead Sciences, Inc. 2013]
  6. [| OLYSIO Prescribing Information. Janssen Products, LP 2013.]
  7. 7.0 7.1 [| VICTRELIS Prescribing Information. Merck & Co., Inc. 2013.]
  8. 8.0 8.1 [| INCIVEK Prescribing Information. Vertex Pharmaceuticals Incorporated, 2013.]
  9. 9.0 9.1 "Chronic Hepatitis B: Integrating Long-Term Treatment Data and Strategies to Improve Outcomes in Clinical Practice".
  10. Lai, CL.; Shouval, D.; Lok, AS.; Chang, TT.; Cheinquer, H.; Goodman, Z.; DeHertogh, D.; Wilber, R.; Zink, RC. (2006). "Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B.". N Engl J Med. 354 (10): 1011–20. doi:10.1056/NEJMoa051287. PMID 16525138. Unknown parameter |month= ignored (help)
  11. "http://jid.oxfordjournals.org/content/204/3/415.full". External link in |title= (help)