Contraindication	Reason for contraindication
Absolute
Allergy to pegylated interferon or ribavirin	—
Decompensated cirrhosis	Treatment can be considered only in the context of established protocols at liver transplantation centers.
Active intravenous drug use or heavy alcohol use*	Ongoing alcohol consumption greatly reduces the chance of successful treatment; minimal alcohol use does not appear to be harmful.
	Intravenous drug users are at high risk for reinfection.
	Alcohol and drug use raise issues about compliance with therapy.
Pregnancy	Ribavirin is highly teratogenic: it damages fetuses, eggs, and sperm. Effective contraception is imperative during treatment and for six months after treatment.
Relative
Anemia, leukopenia, or thrombocytopenia	Combination therapy reduces all hematologic cell lines.
Autoimmune disease	Pegylated interferon acts as a general immune system stimulant and, thus, worsens most autoimmune diseases; however, it does not appear to exacerbate some diseases, such as Crohn’s disease and ulcerative colitis.
Coronary artery disease	Ribavirin causes an anemia that can precipitate ischemia in a heart that has little reserve.
	Coronary artery disease is not an absolute contraindication to the use of pegylated interferon monotherapy.
Severe psychiatric disease, especially severe depression	Pegylated interferon may cause or exacerbate depression; there have been associated instances of suicide.
	HCV-infected patients with mild depression are candidates for treatment.
	Consider a psychiatric consultation before treatment is initiated.
Current psychosis or a history of psychosis	Pegylated interferon may exacerbate psychosis.
	With adequate psychiatric support and close follow-up, some patients with advanced HCV disease may be considered for treatment.