Combination Antiviral Therapy for Hepatitis C

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Combination Antiviral Therapy for Hepatitis C


Generic NameBrand Name
peginterferon alfa-2a and ribavirinPeginterferon
peginterferon alfa-2b and ribavirinPegintron/Rebetol Combo Pack

How It Works

Combination antiviral therapy helps prevent the virus that causes hepatitis C from reproducing in the body. Peginterferon and ribavirin are combined to give the best response to treatment. A protease inhibitor (such as boceprevir or telaprevir) also may be given along with peginterferon and ribavirin.

Peginterferon is given as a shot once a week. Ribavirin is taken as a pill 2 times a day. During the course of your treatment, your doctor frequently may adjust the amount of medicine you are taking.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. If you have genotype 1 and your viral load does not improve after 3 months of treatment, your treatment may be stopped.

Why It Is Used

Combination antiviral therapy is prescribed for people who have ongoing (chronic) hepatitis C infection. It may be given to people who have never had treatment or when interferon alone has failed to control the disease.

How Well It Works

Peginterferon—a longer-acting form of interferon—combined with ribavirin is better than standard interferon combined with ribavirin. The two kinds of peginterferon work similarly.1

How well treatment works is measured by whether you still have the virus in your blood 6 months after treatment. Treatment usually works better if you have genotype 2 or 3 than if you have genotype 1. Most studies have shown that treatment with peginterferon and ribavirin works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.2

If you are also infected with HIV, the combination of peginterferon and ribavirin is considered better than standard interferon and ribavirin.3

Combination antiviral therapy is more likely to be effective if you:

  • Have a low level of the hepatitis C virus in your blood when treatment starts.
  • Are infected with genotype 2 or 3.
  • Have a low amount of liver damage when treatment starts.

Many things affect the decision about who should receive antiviral treatment for hepatitis C.4 For example, treatment may be recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of this medicine include:

  • Fatigue, headache, muscle and joint aches, fever, or chills.
  • Nausea, loss of appetite, or weight loss.
  • Irritability, insomnia, or confusion.
  • Depression.
  • Thyroid problems.
  • Hair loss or skin rash.
  • Low levels of red cells, white cells, and platelets in your blood.

If you develop anemia as a result of taking ribavirin, your doctor may prescribe a medicine called erythropoietin to help your body create more red blood cells.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

You will need regular follow-up visits with a liver specialist during treatment. The specialist will order blood tests to check your liver enzyme levels and to see whether the virus is still present.

Peginterferon and other interferons may be given without ribavirin if you have anemia or heart or kidney problems.

People with normal or slightly elevated liver enzyme levels but whose liver biopsy shows little or no liver damage may choose not to have antiviral treatment. Instead, a doctor can monitor the condition with periodic liver function tests and a liver biopsy every 3 to 5 years.

Even if the initial treatment does not eliminate the virus, your doctor may advise you to continue antiviral treatment, because it may reduce liver inflammation. For some people with significant liver damage, antiviral therapy may slow the progression of liver damage or make liver cancer less likely.5 If you already have cirrhosis, some studies show that antiviral therapy can help you live longer.6

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration for use in children ages 3 to 17 years.

If you are obese or have poorly controlled diabetes, you may need to delay treatment until you get your weight or blood sugar under control.

If you have tried interferon in the past and did not get good results, talk to your doctor about newer combinations of peginterferon with ribavirin or the new protease inhibitors for hepatitis C treatment.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Pregnancy advice for women and men

If you need to take this medicine, talk to your doctor about how you can prevent pregnancy.

For women: Do not use this medicine if you are pregnant or planning to get pregnant.


Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.



  1. McHutchison JG, et al. (2009). Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. New England Journal of Medicine, 361(6): 580–593.
  2. Ward RP, et al. (2004). Management of hepatitis C: Evaluating suitability for drug therapy. American Family Physician, 69(6): 1429–1438.
  3. Chung RT, et al. (2004). Peginterferon alfa-2a plus ribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitis C in HIV-coinfected persons. New England Journal of Medicine, 351(5): 451–459.
  4. Management of hepatitis C: 2002. Consensus Development Conference statement, National Institutes of Health Consensus Development Conference (2002 June 10–12). NIH Consensus Development Program. Available online:
  5. Singal AK, et al. (2010). Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis, Clinical Gastroenterology and Hepatology, 8(2): 192–199.
  6. Dienstag JL (2010). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1593–1670. Philadelphia: Churchill Livingstone Elsevier.


ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerW. Thomas London, MD - Hepatology
Last RevisedMay 14, 2012

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