Viral Hepatitis

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Management and Treatment of Hepatitis C Viral Infection: Table 4

for Health Care Providers

Table 4. Monitoring Parameters for Interferon-Based Therapies With or Without Ribavirin

Table 4. Monitoring Parameters for Interferon-Based Therapies With or Without Ribavirin
PARAMETERINTERVALCOMMENTS
ALT = alanine aminotransferase; ANC = absolute neutrophil counts; EVR = early virologic response; Hb = hemoglobin; Hct = hematocrit; WBC = white blood cell count.
WBC with differential, Hb, Hct, platelets, serum creatinineBefore treatment, week 1 or 2, week 4, then monthly or bimonthly during therapy or more frequently as indicated.Prior to therapy, acceptable hematological and biochemical indices: Hb ≥12 g/dL for men and ≥11 g/dL for women; ANC >1.5 k/mm3; platelets >70 k/mm3; serum creatinine <1.5 mg/dL; creatinine clearance >50 mL/min. See Table 8 and Table 9 for dose modifications.
Serum ALTBefore treatment, month 1, then every 1-2 monthsMonitor when performing other tests.
Pregnancy testBefore treatment, monthly during therapy and for 6 months after completing therapyPatients and their partners should use two forms of contraception throughout therapy and for 6 months afterwards; if pregnancy occurs, therapy should be discontinued and the pregnancy monitored closely.
Thyroid-stimulating hormone (TSH)Before treatment and at least every 12 wk during therapyIf TSH becomes elevated, confirm result and check a free thyroxine (T4) level; consider thyroid replacement therapy if indicated.
Blood glucoseBefore treatment and at least every 12 wk during therapyIf blood glucose is elevated, confirm result by checking glycosylated Hb. If elevated, consider starting insulin sensitizer.
HCV RNA by quantitative and/or qualitative assayBefore treatment, 4, 12, and 24 wk during therapy, at end-of-therapy, and 6 months following the completion of therapyConsider discontinuing treatment at 12 wk if <2 log10 reduction in pretreatment HCV RNA. If EVR is not achieved and treatment is continued, discontinue treatment if HCV RNA is detectable at 24 wk if the goal is viral eradication.

An assay with a minimum lower detection limit of HCV RNA <50 IU/mL should be used at 24 wk, end-of-therapy, and 6 months following completion of therapy.
Assess for adverse effects and adherenceAt each routine visitNonadherence impairs response.
Depression screenAt baseline and each routine visitFor patients screening positive, consider antidepressant therapy and/ or referral to mental health specialist.
Substance use assessment (history of alcohol, cocaine, opiate, heroin, or amphetamine use)At baseline and each routine visitIf positive, refer to addiction specialist.