Hepatitis C Worldwide and in Brazil: Silent Epidemic—Data on Disease including Incidence, Transmission, Prevention, and Treatment

Table 3

Recommendations for the treatment of hepatitis C in Brazil according to the Ministry of Health [28, 29].

Hepatitis C                  Treatment
Acute
(i) Conventional interferon (IFN) monotherapy in a daily dose of induction (alpha-2a at a dose of 6 MUI or; alpha-2b at a dose of 5 MUI), subcutaneously (SC), in the first 4 weeks followed by 3 MUI three times per; week for 20 weeks (completing 24 weeks of treatment); or; (ii) conventional IFN-alpha-2a or alpha-2b, 3 MUI, SC, three times per week, associated to oral ribavirin (RBV) 15 mg/kg/day orally for 24 weeks, for those patients at higher risk of intolerance and/or poor treatment adhesion to higher doses of conventional IFN
Chronic hepatitis genotype 1
Association of pegylated interferon (PEG-IFN) and RBV for 48 to 72 weeks: PEG-IFN alpha-2a, 180 mcg, SC, 1 time per week associated with oral RBV 15 mg/kg/day; or; PEG-IFN alpha-2b, 1.5 mcg/kg, SC, one time per week, associated with oral RBV 15 mg/kg/day
Chronic hepatitis monoinfected with genotype 1 and with advanced fibrosis^aor compensated liver; cirrhosis^b
(i) Triple therapy with PEG-IFN alpha, RBV, and telaprevir: oral telaprevir 750 mg, taken 3 times a day (8 hours apart), administered with PEG-IFN alpha and RBV for 4 or 12 weeks (depending on viral response), followed by a response-guided regimen of either 12 or 36 additional weeks of PEG-IFN alpha and RBV (depending on viral response); oral telaprevir 750 mg, taken 3 times a day (8 hours apart), administered with PEG-IFN alpha and RBV. Therapy initiated with double therapy with PEG-IFN alpha and RBV for 4 weeks, and then addition of telaprevir in a triple therapy for 4 or 12 weeks (depending on viral response), followed by a response-guided regimen of either 12 or 32 additional weeks of double therapy with PEG-IFN alpha and RBV (depending on viral response).; (ii) Triple therapy with PEG-IFN alpha, RBV, and boceprevir^c: oral boceprevir 800 mg administered orally three times daily (8 hours apart), administered with PEG-IFN alpha and RBV. Therapy initiated with double therapy with PEG-IFN alpha and RBV for 4 weeks and then addition of boceprevir in response-guided regimen of either 8, 20, or 44 additional weeks of triple therapy
Chronic hepatitis genotypes 2 and 3 in the absence of predictors of low sustained virologic response (SVR)^d,e
Combination of conventional IFN and RBV for 24 weeks: conventional INF alpha-2a or alpha-2b, 3 MUI, SC, 3 times per week, associated with oral RBV; 15 mg/kg/day
Chronic hepatitis genotypes 2 and 3 in the existence of predictors of low SVR^e
Combination of PEG-IFN and RBV for 24 to 48 weeks: PEG-IFN alpha-2a or PEG-IFN alpha-2b, once a week, SC, associated with oral RBV 15 mg/kg/day
Chronic hepatitis genotypes 4 and 5
Association of PEG-IFN alpha and RBV for 48 to 72 weeks: PEG-IFN alpha-2a, 180 mcg, SC, 1 time per week associated with oral RBV 15 mg/kg/day; or; PEG-IFN alpha-2b, 1.5 mcg/kg, SC, one time per week, associated with oral RBV 15 mg/kg/day

aMetavir F3 and F4; or patients with evidence of portal hypertension by endoscopy or imaging tests.
^bPatients with compensated liver disease (Child-Pugh score ≤ 6; class A), with no history of previous decompensation.
^cMay be considered for patients with advanced fibrosis (Metavir F3 and F4/cirrhosis) according to criteria for individualization of treatment that contraindicates the use of telaprevir for 12 weeks.
^dPatients who have predictors of low response to the treatment with conventional INF should receive treatment with PEG-IFN.
^ePredictors of low response to the treatment with conventional INF: METAVIR score ≥ F3; and/or clinical manifestations of liver cirrhosis; and/or viral load higher than 600,000 UI/mL.