The amount of fibrosis on the liver biopsy shows who is progressing most rapidly toward cirrhosis. That is not yet clear. If people are extremely ill with hepatitis, and have decompensated cirrhosis, the treatment with interferon can certainly make them worse in the beginning. And people who have coronary artery disease should always have a stress test before they take ribavirin, which has a side effect of anemia, which can cause heart problems if somebody becomes very anemic. Yes, relapses occur when the virus mutates and produces a different quasispecies, and escapes from lymphocyte control.
Alpha interferon has many side effects.
They can include fatigue, fever, flu-like symptoms, aches and pains, depression, thyroid problems, weight loss, maybe wasting, diarrhea, and nausea. With the doses used, people are likely to feel something. With ribavirin, aside from the anemia there may a little nausea, similar to the AZT nausea, which usually resolves. The AmFAR study is using 3 million units of alpha interferon three times a week, and 400 mg of ribavirin twice daily. It does not matter.