Monitoring, Counseling, and Nonpharmacologic Considerations
Stringent monitoring of treatment efficacy, AEs, medication adherence, and DDIs is recommended for all patients undergoing antiviral therapy for HCV. Four weeks after therapy initiation, CBC, LFTs, and serum creatinine should be assessed. Quantitative tests for HCV RNA are recommended at weeks 4 and 12 and may be considered at week 24 (after completion of therapy). Thyroid-stimulating hormone levels should be evaluated at the beginning and end of therapy if IFN-based treatment is administered. If ribavirin is being considered in women of childbearing age, a serum pregnancy test prior to treatment initiation is recommended.
Prior to therapy initiation, patients should be extensively educated regarding their HCV medications, monitoring plan, and reduction of transmission or reinfection. Patients should be cautioned to avoid the use of alcohol, which can lead to further liver decompensation, including progression of cirrhosis or development of end-stage liver disease. Once therapy has started, patients should be monitored by telephone or in person for medication adherence. Patients should be counseled to report any new prescription or OTC medications to assess for new DDIs during therapy or the potential for new medications to cause hepatotoxicity. Other nonpharmacologic considerations include vaccination for hepatitis A and hepatitis B in susceptible patients.