[Management of side effects induced by antiviral therapy for chronic hepatitis infection]

Recently approved direct-acting antiviral agents (DAA) for the treatment of chronic infection with hepatitis C virus (HCV) genotype 1, protease inhibitors (PI) boceprevir and telaprevir, have substantially increased the rates of sustained virologic response in the treatment of naïve and experienced patients. However, triple therapy came with a burden of a new spectrum of side effects, which may lead to dose reduction and even discontinuation of therapy. Anticipating the adverse events of PIs, informing patients about their risk and manage them appropriately and efficiently is important for safe and successful treatment outcome. Anemia, although not the most common side effect, has emerged as the most significant one. Effective management of anemia includes close monitoring of complete blood count, extensive ribavirin dose reductions, and possible addition of erythropoietin or blood transfusions. In patients on triple therapy, if RBV is stopped for 7 days or more, the PI should also be permanently discontinued. Dose reductions of HCV PIs are not allowed; the HCV PIs are either administered at full dose or discontinued. Successful adherence to treatment can be enhanced by timely informing the patient that most treatment-related adverse effects can be minimized and managed.