Journal Club

Peginterferon and Ribavirin Therapy in Hepatitis C

      

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Click on the link at left to go to your desired page:  Introduction  Page 2  Page 3  Study 1  Study 2  Study 3   Conclusion  Implication for Social Workers  Post-Test

Instructions

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Post-Test

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Objectives:

Upon completion of this course the participant will be able to:

  1. Define what peginterferon and ribavirin are and their composition.
  2. Define the main goal of hepatitis C treatment therapy with peginterferon and ribavirin.
  3. List four possible adverse reactions to peginterferon/ribavirin therapy.
  4. Describe the cost issues surrounding peginterferon/ribavirin therapy.

Introduction:

Pegylated interferon in combination plus ribavirin is the treatment of choice for hepatitis C due to its efficacy and ease of use. This Journal Club examines this relatively new drug combination and its use in the treatment of hepatitis C as seen in recent clinical research. 

The first study demonstrates the differences in efficacy between pegylated and non-pegylated (unmodified) interferon. The second study compares two dosing schedules using pegylated interferon, with a single dosing schedule for non-pegylated interferon. The final Journal Club entry will explore a comparison between pegylated interferon plus daily ribavirin, unmodified interferon with daily ribavirin, and pegylated interferon as monotherapy in patients with chronic hepatitis C complicated by cirrhosis.

In order to appropriately discuss the use of peginterferon in the treatment of chronic hepatitis C it is necessary to understand what hepatitis C is, how it is transmitted and its symptoms. It is also important to understand the role of interferon in the treatment of hepatitis C.

What is Hepatitis C

Hepatitis C is a liver disease that is caused by the hepatitis C virus (HCV). It is the most serious form of hepatitis. When the virus enters the liver cells in the body, it uses the cell’s inner genetic machinery to make copies of itself, leading to infection of more cells. In about 15% of cases, hepatitis C infection is acute, meaning it is cleared spontaneously by the body and there are no long term side effects. However, in the remaining 85% of cases, the infection becomes chronic and slowly damages the liver over many years. Over time, this liver damage can lead to cirrhosis of the liver, end-stage liver disease, and liver cancer.

In the United States, hepatitis C affects about 4 million people, making it much more prevalent than HIV infection. In fact, it is the most common blood borne infection in the United States. Hepatitis C is now the leading cause of liver transplants in the United States.

Transmission

Hepatitis C is spread through exposure to hepatitis C virus-infected blood. This can occur through a number of means: intravenous drug use, needlestick injuries, high-risk sexual behavior, blood transfusions contaminated with HCV, hemodialysis equipment that has become contaminated, tattoos or body piercings using contaminated equipment, as well as others. Activities that are considered risky include the illegal injection drug use, blood transfusions before 1992, hemodialysis, multiple sexual partners, tattoos, body piercings, and workplace exposure to blood.1

People infected with hepatitis C usually do not display any characteristic disease symptoms. Unlike other forms of hepatitis, hepatitis C infection usually does not result in jaundice. When symptoms do appear, they are usually vague. These may include fatigue, rash, and stomach pain. There may be no abnormal physical findings. With more severe disease spider angiomas, palmar erythema, hepatomegaly, and cryoglobulinaemia may be found. With the development of cirrhosis an enlarged liver and spleen may be evident and weakness, wasting, edema, ascites and variceal hemorrhage may occur with disease progression. Older patients may present for the first time with complications of cirrhosis or even hepatocellular carcinoma.2 Because of this lack of symptoms, many people that are infected with hepatitis C do not know they are infected and therefore continue to infect others. The only way to know if a person has hepatitis C is through a lab workup (blood screening).

Click on the link at left to go to your desired page:  Introduction  Page 2  Page 3  Study 1  Study 2  Study 3   Conclusion  Implication for Social Workers  Post-Test

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