[Management of patients infected with hepatitis C virus]

CHRONIC INFECTION AND CIRRHOSIS: In France, the prevalence of hepatitis C virus (HCV) infection reaches an estimated 1% of the general population. Careful management is required since about 75% of all infected subjects will develop chronic liver disease with the risk of progression to cirrhosis. The major improvements in the efficacy of treatments developed over the last decade should help reduce the incidence of cirrhosis-related complications. PRACTICAL STEPS: A liver biopsy should be performed in all HCV-positive patients in order to study the histological impact. An antiviral treatment should be prescribed for patients free of decompensated cirrhosis or contraindications who have moderate to severe histological lesions.

Alpha-interferon (3 MU three times a week) in combination with ribavirin (1000-1200 mg/d) should be given for 6 to 12 months. Resent publications have reported promising results with pegylated interferon which would be more effective and only require one injection per week. This new interferon, given in association with ribavirin, will undoubtedly shortly become the gold standard treatment for patients with chronic hepatitis C, particularly those infected with treatment-resistant geno-types.