Patient subgroups
This section details the SIGN guidance pertaining to treatment efficacy and safety in a variety of patient subgroups.
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Patients with mild chronic hepatitis
In patients with mild CHC the efficacy and safety of non-pegylated IFN alfa-2a and ribavirin combination therapy is similar to that in other patients with hepatitis C. Liver biopsy to exclude patients with mild disease is therefore not required prior to considering antiviral treatment.133 1++
Patients with mild CHC should be considered for treatment with a combination of pegylated IFN with ribavirin.
Patients with cirrhosis
See Patients with cirrhosis on the Treatment of advanced infection page for information.
Patients with persistently normal ALT levels
The efficacy and safety of pegylated IFN alfa-2a and ribavirin combination therapy in patients with CHC and persistently normal ALT level is similar to that seen in patients with elevated ALT levels.134 See also the section on Alanine aminotransferase. 1+
Patients with chronic hepatitis C and normal AL T should be considered for treatment with pegylated IFN and ribavirin.
Patients with HIV co-infection
Pegylated IFN and ribavirin for 48 weeks is effective in treating patients with HCV and HIV co-infection, leading to sustained viral response in 60% of patients with genotype 2 and 3 and 14-29% in patients with genotype 1. For patients with genotype 1 infection and low HCV viral load (<800,000 IU ml), the sustained viral response rate is around 60%.135-137 1+
98% of patients with HIV/HCV co-infection who did not have an EVR at week 12 did not achieve an SVR at week 48.137 1+
Patients with CHC and HIV should be considered for treatment with a combination of pegylated IFN and ribavirin for 48 weeks irrespective of genotype.
For patients with HCV genotype 1 infection and HIV, the lack of an early viral response at week 12 predicts those who are unlikely to obtain an SVR, and treatment can be stopped.
Patients with hepatitis B co-infection
Treatment outcomes with a combination of non-pegylated interferon and ribavirin in co-infected patients with chronic hepatitis B and C are similar to those achieved in patients with HCV monoinfection. 138, 139 No trials were found examining pegylated interferon and ribavirin in patients co-infected with chronic hepatitis B and C. 2++
Patients with chronic hepatitis B and C co-infection should be considered for combination treatment with pegylated IFN and ribavirin.
Patients in drug treatment programmes
In patients with CHC who are on a stable drug treatment programme, management with a combination of pegylated IFN and ribavirin is effective, leading to high levels of sustained viral response. Whilst drop-out rates are higher than in other cohorts, the drop-outs occur early, within the first eight weeks. After eight weeks compliance is similar to other groups.42, 140 2+
Patients with CHC who are on a drug treatment programme can be considered for treatment with a combination of pegylated IFN and ribavirin.
Good practice points
Active drug users should be engaged in efforts to address their healthcare needs and in harm reduction.
Active drugs users should have a comprehensive assessment of their psychological needs and of their likely adherence to antiviral treatment.
