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General practitioner's section
 
3 Circumstances When a Patient of Hepatitis C should not be Treated
O P Kapoor
 

Once the Anti HCV test is reported to be positive, Hepatitis C infection is diagnosed. But remember the following:-

  1. Do not treat the patient, unless the HCV PCR is positive. This test is a must. If it is negative, then the patient has already recovered from Hepatitis infection and does not need any treatment.
  2. Before starting the treatment which is very costly, (combination of Peg Interferon and Ribavirin) it is worth while for the patient to spend on genome studies (there are six genomes of Virus C). Preferably treat only those patients, whose genome is Type 3. Do not treat patients, who have genome type 1A and 1B.
  3. Do not start the treatment of Hepatitis C, unless the liver functions become abnormal (especially if the levels of SGPT are abnormal).
 

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

An HIV infected person can possibly live a normal lifespan today, provided she or he takes highly active antiretroviral therapy and takes it perfectly. As pointed out by Sabin et al even though new drugs are available each year, a noteworthy proportion of people are at risk of exhausting their treatment options. This proportion is only an imperfect surrogate of the presence of mutations giving rise to resistance to antiretrovirals.

BMJ, 2005; 330 : 166.

HIV PATIENTS NEED NEW ANTIRETROVIRAL DRUGS

Some HIV infected patients taking highly active antiretroviral therapy may be in danger of exhausting their treatment options, and new drugs with low toxicity to which the virus is not resistant need to be developed urgently. In a multicentre cohort study lasting seven years and including 16,593 patients in southeast England, Sabin and colleagues assessed the association of exposure to antiretroviral drugs, CD4 cell count, and plasma HIV RNA burden. Although patients' immunological and virological status generally improved, a small but growing proportion of patients seemed to be in danger of exhausting current treatment options.

BMJ, 2004; 196, 233.