Combination therapy with interferon-alfa and ribavirin is generally recommended for those with moderate-sever disease (histological diagnosis of significant scarring and/or significant necrotic inflammation). While NICE guidance suggests that problems with drug interactions, safety, and compliance may arise in existing intravenous drug users, those who have given up the habit should not be excluded from therapy. However, treatment is not generally recommended in those patients who consume large quantities of alcohol, given the increased risk of liver damage.
In cases where a liver biopsy carries a high risk (e.g. haemophilia), treatment can be initiated without histological confirmation.
Both treatment-naïve patients and those who have relapsed following initial response to interferon-alfa should be considered for 6 months of combination therapy.
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