Therapie der chronischen Hepatitis C - Was ist bei „Problempatienten” zu beachten?

Zusammenfassung

Die antivirale Therapie der chronischen Hepatitis C mit pegyliertem Interferon-α und Ribavirin hat sich in den letzten Jahren fest etabliert und zu deutlich verbesserten Behandlungserfolgen geführt. Für viele Patienten ist die Infektion mit dem Hepatitis-C-Virus (HCV) damit zu einer heilbaren Erkrankung geworden. Nicht selten liegen allerdings Problemsituationen vor, welche die Indikationsstellung zur Therapie und ihre Durchführung erschweren. Depressionen, Drogen- oder Alkoholabusus, eine HIV-Koinfektion oder eine Niereninsuffizienz galten bislang als absolute oder relative Kontraindikation zur Kombinationstherapie mit Interferon-α und Ribavirin. Unter bestimmten Voraussetzungen und/oder begleitenden Maßnahmen ist eine erfolgreiche HCV-Therapie bei kalkulierbarem Nebenwirkungsprofil inzwischen jedoch auch bei vielen dieser „Problempatienten” möglich.

Summary

Combination therapy of chronic hepatitis C with pegylated Interferon-α alpha and ribavirin has become accepted standard. Therapy response markedly improved and many patients now can be cured. But in several situations therapy decision and course are complicated by individual patient related issues. Psychiatric side effects such as depression, abuse of illicit drugs or alcohol, co-infection with HIV (human immunodeficiency virus), or impaired renal function were all dealt as contraindications for an Interferon-α/ribavirin therapy. Under certain circumstances and/or with concomitant arrangements a successful initiation and maintenance of a hepatitis c virus (HCV) therapy with a calculated risk for side effects seems increasingly applicable in „problem patients” now.

Key Words

hepatitis C - treatment - pegInterferon-α - ribavirin - hiv-coinfection - active drug use - depressive illness - renal disease

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