for Health Care Providers

Table 11. Monitoring While on Pegylated Interferon Plus Ribavirin Combination Therapy*

Parameter	Interval	Recommended Action/Comments
Adapted from the VA Treatment Recommendations for Patients with Chronic Hepatitis C *The pharmaceutical package insert for pegylated interferon alfa-2a (40 kD) recommends discontinuation when platelets fall below 25 x 10⁹/L, but the pharmaceutical package insert for pegylated interferon alfa-2b (12 kD) recommends discontinuation when platelets fall below 50 x 10⁹/L.
Hgb,Hct,WBC/diff, and Platelet Count	Week 1 or 2, and week 4, then monthly or bimonthly during therapy. Monthly intervals are recommended in patients with values below the lower limit of normal	Permanently discontinue both drugs if Hgb <8.5 g/dl, Neutrophil <0.5 x 10⁹/L, or Platelets <25 x 10⁹/L**
Serum ALT	Month 1, then every 2-3 months	Monitor when doing other tests
Pregnancy test	Monthly during therapy and for 6 months after completing therapy	Male patients and/or partners receiving combination therapy should use barrier contraceptives plus one other form of effective contraception throughout and for 6 months after therapy If a positive pregnancy test is confirmed, therapy should be discontinued and the outcome of the pregnancy monitored closely
HCV RNA (By a quantitative assay)	12 wk on therapy	Consider discontinuing treatment for patients who remain viremic at 12 wk and who have failed to have at least a two log reduction in viral load from pretreatment level
HCV RNA (By a sensitive assay (minimum lower limit of detection of <50 IU/mL)	End of therapy and 6 months following the completion of therapy	Essential for defining on-treatment and posttreatment response
Depression screen	At each routine visit	For patients screening positive, consider antidepressant and/or Mental Health referral
TSH	Every 6 months before treatment and at 6 and 12 months on treatment	If TSH becomes elevated, confirm result and consider thyroid replacement therapy
Liver biopsy		Repeat after baseline rarely needed