title: Treatment of HCV: approach to difficult cases.
abstract: The treatment of patients with HCV in itself represents a challenge for the treating physicians, but is particularly difficult in special situations where experience is limited. In patients with normal aminotransferases or an incomplete response to IFN, the safety of IFN administration is not the major issue, but one should consider the limited effectiveness of the therapy. In other patients, such as those with concomitant autoimmune hepatitis, an immunosuppressed state or a major psychiatric illness, IFN can be administered but may be associated with serious risks. In these cases, IFN should be used under strictly supervised circumstances and only by physicians with considerable familiarity with the drug. After needle stick exposures, IFN may prevent progression of acute infection to chronic hepatitis. Finally, in patients with well-established cirrhosis, IFN treatment may prevent decomposition or the development of hepatocellular carcinoma. In each of these categories, treatment must be tailored to the individual case based on good clinical judgment. It is hoped that greater experience, newer therapies, and a better understanding of the natural history of HCV infection will simplify the treatment of these cases that currently present difficult management problems.
authors.affiliation: Division of Hepatology, Center for Liver Diseases, University of Miami School of Medicine, Miami, Florida, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Schiff
authors.forename: F M
authors.initials: FM
authors.lastname: Tagle
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D003449:Cryoglobulinemia / Q000276:immunology / Q000821:virology; D015658:HIV Infections / Q000276:immunology / Q000821:virology; D016174:Hepacivirus; D006509:Hepatitis B / Q000276:immunology / Q000821:virology; D006526:Hepatitis C / Q000276:immunology / Q000821:virology; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000201:enzymology / Q000276:immunology / Q000821:virology; D019693:Hepatitis, Autoimmune / Q000201:enzymology / Q000276:immunology / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000276:immunology / Q000821:virology; D001523:Mental Disorders / Q000276:immunology / Q000821:virology
chemical_list: D000410:Alanine Transaminase