In essence, he does not believe that people failed treatment, but that treatment failed them. The proposed guidelines the VA circulated late last year lay out a roadmap for treatment. For patients never treated before who are generally healthy, they recommend combination therapy with interferon and ribavirin. After six months, doctors evaluate patients' response to treatment. Genotypes-2 or 3 receive only six months of therapy.
Many conditions make treatment with ribavirin impractical or impossible.
Ribavirin can cause significant anemia, so patients with cardiac disease or pre-existing anemia are not good candidates. She says these patients would need an extensive, and expensive, medical work-up before putting them on ribavirin, and close monitoring during such therapy. Based on response at three months, treatment may continue for a full 48 weeks. Therefore, retreatment is a common concern. Dr. Imperial says she almost always uses monotherapy for retreatment of relapsers in her practice, prescribing Infergen at 15 micrograms for the majority of them.