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Testing, Coinfection, Treatment and Support
By Simon Collins and Tracy Swan
August 2007
Side Effects and Management Strategies
The side effects from hepatitis C treatment can be uncomfortable,
sometimes debilitating, and, rarely, even life-threatening. People who
are coinfected with HIV and hepatitis C may have more severe side
effects. There are ways to manage these side effects.
It can be very helpful to talk with people who have been on
hepatitis C treatment, and to ask your doctor how he/she will treat
your side effects.
With the right planning and support, many side effects can be
managed. Support from other people with HCV, friends, and family before
and during HCV treatment plays a key role in coping with side effects.
Depression, Anxiety and Other Psychiatric Side Effects
Depression and anxiety are commonly reported side effects of
interferon treatment. In rare cares, people have reported that they
have felt like taking their own lives, and a few people have committed
suicide during their HCV treatment. People with a history of depression
are at greater risk for developing these side effects during HCV
treatment, although depression and anxiety have also been reported in
people who never experienced them before. Interferon can also cause
irritability, insomnia, mania, mood swings, and psychosis.
It's important to have access to mental health care before and
during HCV treatment, so that psychiatric side effects can be treated
promptly and appropriately, if it becomes necessary.
Starting an antidepressant before going on HCV treatment can help to prevent depression from interferon.
Antidepressants and other psychiatric medications have their own
side effects, so other experts think it is better to provide these
drugs only if and when people need them.
It is important to correctly diagnose and properly treat psychiatric symptoms of HCV treatment.
Flu-Like Symptoms
Flu-like symptoms (fever, aches and pains, headache, chills, and nausea) are common side effects of interferon.
Taking the pegylated interferon shot in the evening helps, as does a
low dose of acetaminophen and anti-nausea medication and/or dronabinol
(also called Marinol, a derivative of marijuana).
Drinking plenty of water helps to lessen flu-like symptoms.
Weight Loss
Weight loss often occurs during HCV treatment, because people may
lose their appetite, have diarrhea, and/or feel nauseated. If possible,
eat many small, light meals to keep energy up. Dronabinol may help to
stimulate appetite.
D4T (stavudine) should not be used as it can increase fat loss when used with ribavirin.
Fatigue
Fatigue is also common; napping and regular but light exercise, when
possible, can help. Some doctors are treating fatigue with
methylphenidate (Ritalin).
Anemia, Neutropenia and Thrombocytopenia
HIV-positive people may have low white and/or red blood cell counts;
neutropenia, anemia, and thrombocytopenia sometimes develop in persons
with advanced HIV disease. Regular monitoring of white and red blood
cell counts during HCV treatment is especially important for coinfected
people, since they are at greater risk for anemia, neutropenia, and
thrombocytopenia.
Anemia (an abnormally low red blood cell count) is a side effect of
ribavirin, and pegylated interferon can also cause anemia because it
suppresses the growth of bone marrow, where blood cells develop. The
most common symptom of anemia is fatigue. Anemia is a common problem
for HIV-positive people, and can be caused by AZT. If possible,
coinfected people should avoid taking AZT, especially during HCV
treatment. Both AZT and ribavirin can cause anemia, and combining them
increases the risk. Combivir and Trizivir both contain AZT.
There are two ways to treat anemia due to ribavirin. One strategy is
to lower the dose of ribavirin, but HCV treatment may not work as well.
The other is to treat anemia with injections of a red cell growth
factor called Epogen, which improves fatigue and helps people to stay
on ribavirin. Severe anemia is treated by blood transfusions, but this
can be avoided by reducing the ribavirin dose or starting red cell
growth factor if anemia develops during HCV treatment.
Neutropenia is an abnormally low amount of neutrophils, the white
blood cells that fight bacterial infections. Pegylated interferon can
cause neutropenia. The risk of developing bacterial infections is
increased in people with neutropenia. If the neutrophil count drops
during HCV treatment, the dose of pegylated interferon is reduced, or
neutropenia is treated with injections of white cell growth factor
called Neupogen.
Thrombocytes are platelets that help stop bleeding by clotting
blood. Thrombocytopenia (low platelet count) can be caused by serious
liver damage (because platelets are made in the liver). It can also be
caused by other medical conditions, including HIV itself, and by
pegylated interferon. Severe thrombocytopenia can have life-threatening
consequences, such as intracranial hemorrhage. If severe
thrombocytopenia develops during HCV treatment, it is usually
discontinued.
HCV Treatment and CD4 Cell Count
Although interferon can cause a temporary drop in your CD4 count,
(but not your CD4 percentage), the three major HCV treatment trials for
coinfected people did not find more opportunistic infections (OIs) in
people with low (under 200/mm3) CD4 cell counts.
There have been some reports of Candida esophagitis (a fungal
infection of the esophagus), and tuberculosis among coinfected people
during HCV therapy. In some cases, prophylaxis (drugs that protect
against certain OIs) may be recommended.
CD4 cell counts usually return to the pretreatment levels within a few months after HCV treatment has ended.
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