ÎTreatment may be discontinued in patients who do not achieve an early virological response (EVR ≥ 2 log reduction in HCV RNA at week 12 of treatment) (I-A).
ÎPatients who do not achieve a complete EVR (undetectable HCV RNA at week 12 of treatment) should be retested at week 24, and if HCV RNA remains positive, treatment should be discontinued (I-A).
Failure of Primary Treatment — Genotypes 2-4
ÎRe-treatment with PegIFN plus RBV in patients who did not achieve an SVR after a prior full course of PegIFN plus RBV is NOT recommended, even if a different type of PegIFN is administered (for relapsers, III-C; for non-responders, III-B).
ÎRe-treatment with PegIFN plus RBV can be considered for non- responders or relapsers who have previously been treated with non- pegylated interferon with or without RBV, or with PegIFN monotherapy, particularly if they have bridging fibrosis or cirrhosis (IIa-B).
ÎMaintenance therapy is NOT recommended for patients with bridging fibrosis or cirrhosis who have failed a prior course of PegIFN and RBV (III-B).
Adverse Reactions
ÎIf a patient has a serious adverse reaction related to PegIFN and/or RBV, the PegIFN and/or RBV dose should be reduced or discontinued. If either PegIFN and/or RBV are discontinued, the HCV protease inhibitor (PI) should be stopped.
ÎPatients who develop anemia on PI-based therapy for CHC should be managed by reducing the RBV dose (IIa-A).
ÎPatients on PI-based therapy should undergo close monitoring of HCV RNA levels. The PIs should be discontinued if virological breakthrough (> 1 log increase in serum HCV RNA above nadir) is observed (I-A).
ÎPatients who fail to have a virological response, who experience virological breakthrough or who relapse on one PI should NOT be re-treated with the other PI (IIa-C).
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