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The rationale for treatment is that the fatigue produced by interferon and ribavirin-related anemia is associated with reduced quality of life. Moreover, anemia may result in severe adverse events, in a need of blood transfusion and in failure to meet treatment-adherence goals. 108 At week 16, the mean daily doses of ribavirin were 700 and 900, respectively. Therefore, if epoetin is started before the hemoglobin level drops below 11g/dL, a ribavirin dose reduction can be avoided. Patients who are anemic at baseline can be started on epoetin prior to treatment.
If relapse occurs after the optimized combination ribavirin interferon, the best strategy is unknown: longer duration or inclusion in randomized trials should be discussed. Nonresponders A nonresponder is defined as a patient with still detectable HCV RNA in the serum at the end of the treatment. A nonresponder after interferon alone (24 or 48 weeks) or after the combination ribavirin standard interferon should be treated by the combination of PEGIFN and ribavirin adjusted by weight. Maintenance or suppressive therapy In nonresponders, after the combination of PEG-IFN and ribavirin for at least 24 weeks, the best strategy is unknown.
Even the 24-week regimen induces a sustained response in 4% of these patients. 55,56,59 The choice of 24 or 48 weeks for nonpegylated interferon and ribavirin combination therapy has been clarified. The crucial time to make this decision is at 24 weeks based on the results of HCV PCR testing. In patients who are PCR negative at 24 weeks (59% of the patients in these studies), the goal is to reduce the relapse rate. There was an overall highly significant improvement with 48 weeks of treatment (74% sustained responders) versus 24 weeks (59% sustained responders).