Diagnosis and management of chronic hepatitis C

Chronic HCV infection is a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma worldwide. The disease is indolent or subclinical in the majority of patients but alcohol consumption and older age at infection may be associated with an accelerated course. Current diagnostic modalities are highly sensitive and specific in confirming the diagnosis and may help predict response to therapy. Treatment with interferon is effective in clearing the virus in a small number of patients but the addition of ribavirin results in an enhanced overall chance of viral eradication. The development of an effective vaccine to HCV is presently encumbered by the presence of multiple viral genomic subtypes and the high rate of spontaneous viral mutation leading to limited efficacy of neutralizing antibodies.