Meet the HEP C Challenge

The decision to continue IFN-a therapy in such cases should be individualized. If the chance of achieving viral clearance with IFN-a therapy is considered high (patients with genotypes -2/3 or patients with genotype -1 and low pretreatment viral load and/or a favorable virological response after three months of therapy), every effort should be made to continue IFN-a therapy. In such cases, the use of adjunctive medications for RA like low dose prednisone (<10 mg/day) or even anti–TNF-a agents could be tried.

In cases where the possibility of viral clearance is low (patients with genotype-1 and high pretreatment viral load and/or absence of virologic response after three months of therapy) or where a severe exacerbation of arthritis not controlled with therapy is noted, we believe that IFN-a therapy should be stopped.

Conclusions

HCV is a common chronic viral infection that affects the diagnosis and management of RA in numerous ways. Rheumatologists should become knowledgeable about the clinical aspects of HCV infection, develop standards for screening, and establish close relationships with hepatologists skilled in assessing and managing patients with these complex disorders. Still, there are a number of questions that need to be answered concerning the long-term safety of biologic therapies in patients with chronic hepatitis C, as well as the antiviral and antirheumatic efficacy of combination therapies with antivirals and biologics in this group of patients. A number of trials are already in progress that will try to answer these questions, and certainly more are needed in the future.

Dr. Vassilopoulos is assistant professor of medicine–rheumatology at Athens University in Greece. Dr. Calabrese is professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and R.J. Fasenmyer Chair of clinical immunology and vice chair of the department of rheumatic and immunologic diseases at the Cleveland Clinic Foundation.

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