Selecting a Treatment Regimen
ÎWhen possible, patients receiving zidovudine (AZT) and especially didanosine (ddI) should be switched to an equivalent antiretroviral agent before beginning therapy with RBV (I-C).
ÎHIV-infected patients with decompensated liver disease (Child- Turcotte-Pugh [CTP] Class B or C) should
be treated with PegIFN
alfa and RBV and may be candidates for liver transplantation (IIa-C). Patients with Kidney Disease
ÎAll persons with chronic kidney disease awaiting renal replacement therapy, namely hemodialysis or kidney transplantation, should be screened for hepatitis C in order to plan for management and treatment (I-B).
ÎThe decision to perform a liver biopsy in patients with kidney disease should be individualized, based upon the clinical assessment of need for therapy and the need to establish the severity of the liver disease (IIa-C).
ÎPersons with chronic HCV infection and mild kidney disease (glomerular filtration rate > 60 mL/minute) can be treated with the same combination antiviral therapy as that used in persons without kidney disease (IIa-C).
ÎPersons with chronic HCV infection and severe kidney disease not undergoing hemodialysis can be treated with reduced doses of both PegIFN (alpha-2a, 135 mcg/week; alpha-2b, 1 mcg/kg/week) and RBV (200-800 mg/day) with careful monitoring for adverse effects (IIa-C).
ÎTreatment of HCV in patients on dialysis may be considered with either standard interferon (2a or 2b) in a dose of 3 mU three times weekly or reduced dose pegylated interferon 2a, 135 mcg/week or 2b, 1 mcg/kg/week (IIa-C). RBV can be used in combination with interferon in a markedly reduced daily dose with careful monitoring for anemia and other adverse effects (IIb-C).
ÎTreatment is recommended for patients with chronic HCV
infection who have undergone kidney transplantation, unless they develop fibrosing cholestatic hepatitis (III-C).
ÎPatients with cryoglobulinemia and mild to moderate proteinuria and slowly progressive kidney disease can be treated with either standard interferon or reduced doses of pegylated interferon alfa and RBV (IIa-C).
ÎPatients with cryoglobulinemia and marked proteinuria with evidence of progressive kidney disease or an acute flare of cryoglobulinemia can be treated with rituximab, cyclophosphamide plus methylprednisolone, or plasma exchange followed by interferon-based treatment once the acute process has subsided (IIa-C).
12
N
OT
N
OT
