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Management of the side effects of peginterferon and ribavirin used for treatment of chronic hepatitis C virus infection

T Barry Kelleher, MD, FRCPI
Nezam H Afdhal, MD, FRCPI
Section Editor
Adrian M Di Bisceglie, MD
Deputy Editor
Allyson Bloom, MD


Side effects are observed in almost 80 percent of patients receiving peginterferon and ribavirin combination therapy for chronic hepatitis C virus (HCV) infection (figure 1). Care of patients with chronic HCV infection depends upon recognition of those at increased risk for side effects, anticipation (and prevention) of side effects, and appropriate response when they occur. Furthermore, the ability to achieve a sustained virologic response (SVR) to therapy depends in part upon the degree of compliance with therapy. Reduction of the dose of these agents (or their discontinuation) due to side effects can potentially compromise the outcome, depending upon when dose reduction occurs.

Although treatment paradigms for chronic hepatitis C are rapidly evolving, peginterferon and ribavirin, typically in combination with a direct-acting antiviral, remain in use for certain genotypes, particularly in resource-limited settings where newer interferon-free regimens are inaccessible or unavailable. With a few exceptions, the majority of the side effects reported in trials of such triple combination therapy are similar in nature and frequency to those seen with peginterferon and ribavirin.

This topic review will summarize the major side effects associated with regimens for the treatment of HCV infection that include peginterferon and ribavirin. A detailed discussion on treatment regimens and side effects of directly acting antivirals is presented separately. (See "Treatment regimens for chronic hepatitis C virus genotype 1 infection in adults" and "Treatment regimens for chronic hepatitis C virus genotypes 2 and 3 infection in adults".)


Side effects are frequent with the use of peginterferon and ribavirin for the treatment of chronic HCV, thus patients should be evaluated regularly for toxicity during the course of therapy (table 1).

Certain laboratory and other specialized testing to assess for specific side effects are warranted at baseline and/or during HCV treatment with peginterferon and ribavirin. These include:

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Literature review current through: Nov 2017. | This topic last updated: Apr 12, 2016.
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