Guidelines for the treatment of chronic hepatitis and cirrhosis due to hepatitis C virus infection for the fiscal year 2008 in Japan |
| |
| Authors: | Hiromitsu Kumada Takeshi Okanoue Morikazu Onji Hisataka Moriwaki Namiki Izumi Eiji Tanaka Kazuaki Chayama Shotaro Sakisaka Tetsuo Takehara Makoto Oketani Fumitaka Suzuki Joji Toyota Hideyuki Nomura Kentaro Yoshioka Masataka Seike Hiroshi Yotsuyanagi Yoshiyuki Ueno The Study Group for the Standardization of Treatment of Viral Hepatitis Including Cirrhosis Ministry of Health Labour and Welfare of Japan |
| |
| Institution: | Department of Hepatology, Toranomon Hospital, Tokyo,;Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita,;Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime,;Department of Internal Medicine, Gifu University, Gifu,;Department of Gastroenterology and Hepatology, Musashino Red-Cross Hospital, Musashino,;Department of Internal Medicine, Shinshu University, Matsumoto,;Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, Hiroshima,;Department of Gastroenterology and Hepatology, Fukuoka University School of Medicine, Fukuoka,;Department of Gastroenterology and Hepatology, Osaka University, Osaka,;Department of Digestive and Lifestyle-related Disease, Health Research Human and Environmental Science, Kagoshima,;Department of Hepatology, Toranomon Hospital, Tokyo,;Department of Gastroenterology, Sapporo Kosei General Hospital, Sapporo,;The Center of Liver Disease, Shin-Kokura Hospital, Kitakyusyu City,;Division of Liver, Biliary Tract and Pancreas Disease, Department of Internal Medicine, Fujita Health University, Aichi,;Department of Internal Medicine, Faculty of Medicine, Oita University, Oita,;Department of Infectious Disease, University of Tokyo, Tokyo, and;Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan |
| |
| Abstract: | In the 2008 guidelines for the treatment of patients with chronic hepatitis C, pegylated interferon (Peg-IFN) combined with ribavirin for 48 weeks are indicated for treatment-naive patients infected with hepatitis C virus (HCV) of genotype 1. Treatment is continued for an additional 24 weeks (72 weeks total) in the patients who have remained positive for HCV RNA detectable by the real-time polymerase chain reaction at 12 weeks after the start of treatment, but who turn negative for HCV RNA during 13–36 weeks on treatment. Re-treatment is aimed to either eradicate HCV or normalize transaminase levels for preventing the development of hepatocellular carcinoma (HCC). For patients with compensated cirrhosis, the clearance of HCV RNA is aimed toward improving histological damages and decreasing the development of HCC. The recommended therapeutic regimen is the initial daily dose of 6 million international units (MIU) IFN continued for 2–8 weeks that is extended to longer than 48 weeks, if possible. IFN dose is reduced to 3 MIU daily in patients who fail to clear HCV RNA by 12 weeks for preventing the development of HCC. Splenectomy or embolization of the splenic artery is recommended to patients with platelet counts of less than 50 × 103/mm3 prior to the commencement of IFN treatment. When the prevention of HCC is at issue, not only IFN, but also liver supportive therapy such as stronger neo-minophagen C, ursodeoxycholic acid, phlebotomy, branched chain amino acids (BCAA), either alone or in combination, are given. In patients with decompensated cirrhosis, by contrast, reversal to compensation is attempted. |
| |
| Keywords: | chronic hepatitis cirrhosis hepatocellular carcinoma hepatitis C virus interferon liver supportive therapy pegylated interferon ribavirin |
|
|
