Hepatitis response-optimized therapy

The use of PCR has now become a standard method to quantify the replication of the HIV and hepatitis viruses in infected patients (the viral load, described as copies per milliliter)." Similar methods are used to determine the presence of genetic mntations in the HIV that are associated with increased resistance to one or more of the many antiretroviral medications available for clinical use. The use of these genotyping methods as an aid to select an optimized antiretroviral regimen has been correlated with an improved clinical response to therapy, as well as with a more potent reduction in the viral load." Guidelines for the use of these assays have been developed by a consensus panel of HIV therapy experts owing their the exceptionally high costs (often in excess of 1000 per test), as weU as the complexity of interpretation of the test results." ... 

Similar to HBV, infections with hepatitis C virus (HCV) have a high rate of progression from an acute to a chronic state that frequently leads to cirrhosis or hepatocellular carcinoma [2]. Monotherapy for HCV infection with IFN-a or combined therapy with ribavirin and IFN-a is associated with initial rates of response as high as 40%. The rates of sustained responses are, however, lower and also depend on the viral genotype. In patients infected with HCV genotype 2 or 3, the response was maximal after 24 weeks of treatment, whereas patients infected with genotype 1 -the most frequent in the USA and Europe - required a minimum treatment course of 48 weeks for an optimal outcome. 

Adults (CHF, hepatic cirrhosis, nephrotic syndrome) - Initially, 100 mg/day (range, 25 to 200 mg/day). When given as the sole diuretic agent, continue for 5 days at the initial dosage level, then adjust to the optimal level. If after 5 days an adequate diuretic response has not occurred, add a second diuretic, which acts more proximally in the renal tubule. Because of the additive effect of spironolactone with such diuretics, an enhanced diuresis usually begins on the first day of combined treatment combined therapy is indicated when more rapid diuresis is desired. Spironolactone dosage should remain unchanged when other diuretic therapy is added. 

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