Peginterferon-alfa-related adverse events
Although pegIFN-alfa remains on the PBS, and until very recently was the only available treatment for Gt 5–6 HCV, it can no longer be recommended as first-line therapy for any patient group. PegIFN-alfa-based therapy is associated with considerable morbidity, resulting in many people being pegIFN-ineligible or intolerant, or unwilling to use it. Intensive on-treatment monitoring is required. The most common adverse effects of pegIFN include influenza-like symptoms (fevers, lethargy and myalgia), fatigue, bone marrow suppression, mood disturbance and alopecia. Less frequently, severe cytopaenia, major depression and psychosis may occur. PegIFN is contraindicated in people with: untreated major depression or psychosis; significant immune-mediated disease (eg, inflammatory arthritis, lupus, ulcerative colitis); and decompensated liver disease (Child–Pugh B and C). PegIFN-based treatment may precipitate hepatic decompensation in people with advanced liver disease; a platelet count < 100 x 109/L and albumin level < 35 g/L identify those at highest risk.58 Thus, treatment should only be considered within a specialised centre. Despite the significant adverse event profile, the discontinuation rate among patients treated with 12 weeks of sofosbuvir plus pegIFN and ribavirin was only 2%,49 similar to that reported for IFN-free regimens.