Three months after beginning an initial course of therapy, patients who are unlikely to respond to that dosage and frequency can be identified by persistent elevation of serum ALT levels and presence of HCV RNA in the serum. In this situation, therapy should be discontinued because the likelihood of future response is extremely low. He now questions you about side effects of interferon alfa therapy. Later side effects include fatigue, alopecia, bone marrow suppression, and neuropsychiatric effects such as apathy, cognitive changes, irritability, and depression. Nocturnal administration of interferon reduces the frequency of side effects, and the flulike syndrome is ameliorated by pretreatment with acetaminophen.
Higher dosages tend to be associated with higher rates of side effects.
J.T. says he knows about that from reading on the Internet. He wants to know about the really BAD stuff. Rare deaths have occurred due to liver failure or sepsis, principally in patients with cirrhosis. The student is ready to draw blood on J.T. before therapy is begun with interferon alfa. Both serum ALT and serum HCV RNA testing should be done after 3 months to assess whether the patient is responding to therapy.