A 55 year old male patient was diagnosed to have chronic hepatitis C. He responded to treatment with interferon. However, after one year of follow up he showed a relapse of disease. Which of the following would be the next most appropriate choice?
Correct Answer: Ribavarin and interferon
Description: Ans. is 'a' i.e. Ribavirin and interferonRef.: Harrison, 17th/ep 1965 & 16th/ep 1851 (15th/e, p1749, Table 297-6)Harrison writes - "Patient who have relapsed after an initial course of interferon monotherapy are candidates for a 6 month course of combination interferon-ribavirin therapy; if they cannot tolerate ribavirin, they should be retreated with interferon monotherapy, but the course should be longer."Treatment of Chronic hepatitis CThere are two approaches to the antiviral therapy of chronic hepatitis Cmonotherapy with interferoncombination therapy with interferon plus ribavirinCombination therapy (interferon + ribavirin) is the treatment of choice unless contraindication to the combination therapy exists.Monotherapy with interferon is the alternative regimen (primarily for pts. in whom combination therapy is contraindicated or not tolerated)Relapses after an initial course of interferon are treated asA 6 month course of combination interferon- ribavirin orA course of interferon monotherapy longer in duration than the original course.For interferon non responders, retreated with interferon monotherapy or combination therapy is unlikely to achieve a sustained response.Contraindication to combination therapyAnemia, hemoglobinopathiesas ribavirin causes hemolysisCoronary artery disease, cerebrovascular ds.anemia caused by ribavirin induced hemolysis can precipitate an ischemic eventRenal insufficiencyas ribavirin is renally excretedPregnancy as ribavirin is teratogenic
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