the virological outcomes and adverse effects of IFNRBV treatment among children.
153
This review included four RCTs and 31 non-randomized studies. The overall SVR rate for PEG-IFN and RBV was 30–100, which is comparable
to SVR rates seen in adults. Adverse effects were primarily lu-like symptoms and neutropenia.
9.4 Persons with liver cirrhosis
The spectrum of disease in those infected with HCV extends from mild ibrosis to cirrhosis and HCC. Between 15 and 30 of persons infected with HCV will
go on to develop cirrhosis of the liver within 20 years and a proportion of these will progress to HCC. The risk is markedly increased in those who consume
excess alcohol
216
and in those coinfected with HBV andor HIV, particularly those who do not have access to ART.
60,61
Persons with compensated cirrhosis have the least time available for treatment, the most to lose and much to gain from
achieving SVR. Treatment of HCV infection with IFN-containing regimens must be commenced before the onset of decompensated disease as it may precipitate
liver failure and death if administered at this stage. Regular clinical examination and monitoring of serum bilirubin, albumin and
blood clotting proile INR is necessary in persons with cirrhosis on IFN-based treatment in order to detect decompensated disease. The treatment of such
persons with IFN-containing regimens carries a higher risk of serious side- effects and the use of haemopoietic factors is recommended in settings where
these are available.
110
Assessment and follow up for the progression of disease and for evidence of HCC is an essential part of the care of persons with HCV-related cirrhosis.
Compensated cirrhosis may also progress over time to decompensated cirrhosis associated with ascites, oesophageal and gastric varices, and eventually to liver
failure, renal failure and sepsis, all of which are life-threatening. The diagnosis of decompensated liver disease is based on both laboratory and clinical assessment,
and therefore a careful medical examination of patients must be made before starting treatment. Persons with cirrhosis including those who have achieved a
SVR should be screened for HCC with six-monthly ultrasound examination and α-fetoprotein estimation, and should have endoscopy every 1-2 years to exclude
oesophageal varices.
110
9.5 Persons with HBV and TB coinfection
