Previously Asked Questions
Welcome to the HCV Advisory committee frequently asked questions page.
Below we have posted the most common asked questions related to the treatment of HCV, along
with responses from any or all of our esteemed advisory committee members.
Click on the question of interest and you will be taken to a list of those responses.
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•Should hepatitis C virus patients be concerned with liver hemangiomas?
•What treatments are available for patients who have not responded to either Peg or Pegasys
or have relapsed after previous treatment success?
•What is the reason a Physician would prescribe 90mcg or 135 mcg of Pegasys?
•Is there any information on side effects from HCV treatment persisting after therapy is complete?
•What is the benefit to early Hepatitis treatment even if HCV levels are not considered "high"?
•Has the drug Alinia been proven effective to cure HCV?
•
What pain meds are ok while taking hep C treatment? Would hydrocodone be a problem?
Should hepatitis C virus patients be concerned with liver hemangiomas?
No not at all. If they have large ones or many it can be a problem with biopsy but otherwise no significance if it clearly is a hemangioma.
Robert Brown, M.D.
In answer to your question hemangiomas should not be of more concern to patients with hepatitis C than to the general population. They usually require no therapy other than observation for change in size with yearly ultrasound or
MRI examinations.
Lewis J Mufson M.D.
No, hemangiomas are totally a benign entity and have nothing to do with hepatitis C.
Barry Migicovsky M.D.
What treatments are available for patients who have not responded to either Peg or Pegasys or have relapsed after previous treatment success?
Failures to Peg and Pegintron and Ribavirin will sometimes respond to consensus interferon (Infergen) and Ribavirin. This drug should in my opinion be given in clinical studies only. One should also consider a liver biopsy to determine extent of disease,
to be considered for maintenance interferon therapy as well, again in clinical study situation. Alternatively awaiting newer therapy which will be available in the future should be considered.
Lewis J Mufson M.D.
The question is really why did they fail therapy or are they true nonresponders. For the true nonresponders the only option is wait and see although protease inhibitors or the equivalent are on the way but will it be the saving grace?
We'll only know in time. other options are maintenance therapy but this too is experimental and I would save this option for the more severe patients. My first concern is the patients that initially failed therapy or relapsed and how effective their initial therapy was.
This has to be looked at individually in order to determine the eventual outcome.
Barry Migicovsky M.D.
What is the reason a Physician would prescribe 90mcg or 135 mcg of Pegasys?
Our office often orders the 90mcg dosage for cirrhotic patients as maintenance in an attempt to halt the formation of firbrosis. A retrospective review of hepatitis C patients treated with combination therapy showed that 60% of the patients that did NOT respond to the treatment still had histological improvement of their livers.
It is believed that the interferon has some antifibrotic effects on the liver and may help prevent progression of the damage to the liver. There are 2 nationwide studies, the Copilot and an NIH study, both of which are 4 years studies, set up to prove that there is benefit to treating patients with low dose interferon.
As for the 135mcg dosage, that would be used if a dose reduction is indicated. Our office tries to initiate Neupogen and Procrit therapy before dose reduction is indicated as the use of full dosing has been show to be extremely beneficial in treatment success.
Cynthia Lachky PA-C
Patients who have major side effects sometimes need lower dose. This should be a rare nescesity.
Lewis J Mufson M.D.
Only if the patient is on a maintenance dose or if the the patient hematological side effects are not responding to the adjunctive therapy including Procrit or the equivalent or Neupogen or the equivalent or severe thrombocytopenia
Barry Migicovsky M.D.
Is there any information on side effects from HCV treatment persisting after therapy is complete?
The drug persists in the body for approximately another 6 months or earlier and thus side effects usually dissapate after 1 month or longer.
Barry Migicovsky M.D.
Patients on Rebetol (Ribaviron) should not become pregnant for at least 6 months after therapy is ended.
Lewis J Mufson M.D.
I don't believe there have been any formal studies. I have had patients who complain of fatigue after completing
therapy and have a sustained viral response. One thought is that the fatigue, which had been attributed to the
disease and/or the treatment, had another cause unrelated to hepatitis C. It has been frustrating for both patients
and practitioners as we all hope the fatigue will completely resolve.
Cynthia Lachky PA-C
What is the benefit to early Hepatitis treatment even if HCV levels are not considered "high"?
I have always felt that the earlier the treatment the better the response.
I have also always felt the less the liver damage the better the response.
As a result of my aggressive attitude toward therapy I have not as of yet seen the need for increasing doses of Pegasys.
The advantage of Pegasys is it is a larger molecule and maintains a higher blood level for a longer period of time. I hope this is of help.
Lewis J Mufson M.D.
Has the drug Alinia been proven effective to cure HCV?
Alinia has recently been used in a clinical trial for HCV in combination with PEG and Riba in Egypt with interesting results.
There are trials ongoing in the US and Europe.
There is an abstract by Rossingol, et al., 2007, Hepatol. 46 (Suppl. 1:316A) you can check out.
It is premature to call it 'effective.'
Milton Mutchnick, M.D.
What pain meds are ok while taking hep C treatment? Would hydrocodone be a problem?
Since all drugs can exert some strain and stress on the liver, patients should not attempt to self-treat pain or discomfort.
Patients should discuss symptoms and pain management with their physician.
Most likely we are talking about a combination drug like Vicodin or Lortab that contains acetaminophen with hydrocodone.
A liver afflicted with hepatitis C may not be able to metabolize this drug.
High doses of acetaminophen can cause liver injury, even to a healthy liver.
In limited dosages, a physician will generally only suggest this class of
analgesic to a person whose hepatic metabolism is fully functioning.
Dr. Maroulis, PharmD
If general, HCV patients can take Tylenol as long as they don’t take large amounts, and NSAIDs,
if they don’t have a coagulaopathy (bleeding problems and/or low platelet count.)
Hydrocodone would be safe , unless the patient has decompensated cirrhosis
which would make the patient susceptible to encephalopathy and should therefore use narcotics with caution.
Dr. Brettholz
Generally speaking, one should avoid opiates on a chronic basis due to drug dependence,
but in the setting of HCV therapy, my main concern with hydrocodone or other opiates is focused on the depressive effects.
N.B. I am making the assumption that the hydrocodone is by itself, e.g. Roxodone, rather than in combination with acetaminophen
(APAP/Tylenol), which carries its own baggage in liver patients once roughly a 2gm daily threshold is exceeded.
I am unaware of any negative interaction between opiates and either the interferon or ribavirin therapy.
CNS side effects can be quite limiting independent of opiate use and any meds that worsen the side effects
may adversely impact the likelihood of successful completion of the prescribed full-dose, antiviral treatment course.
Dr. Fixelle
It is a patient dependent decision. For HCV patients who are addicts or ex-addicts, I usually try to avoid narcotics like hydrocodone. I admit however I have used them in order to keep patients on therapy.
It is also important to have patients premedicate themselves with OTC NSAID like Advil or Motrin before the interferon injection.
I typically try Ultram 50 mg q 4-6 hours as the next choice for pain meds before advancing to narcotic analgesia.
Dr. Phillips