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Chronic Hepatitis C
1Liver Transplant Program, Cedars Sinai Medical Center and University of California, Los Angles, School of Medicine, 8635 West 3rd Street, #590W, Los Angeles, CA 90048, USA. Martinpx@cshs.org
Insights
Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and liver transplants. New therapies combining pegylated interferons with ribavirin show promise for sustained virologic response, considered a cure for HCV.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Hepatitis C virus (HCV) causes 40% of chronic liver disease in the US and is the primary reason for liver transplants.
- An estimated 4 million Americans are or have been infected with HCV.
- Current standard treatment involves recombinant interferon alfa and ribavirin.
Purpose of the Study:
- To review the current and emerging treatments for chronic hepatitis C virus infection.
- To discuss factors predicting treatment response and therapeutic goals.
- To highlight patient management considerations, including counseling and monitoring.
Main Methods:
- Review of current literature on hepatitis C virus (HCV) treatment.
- Analysis of factors influencing sustained virologic response (SVR).
- Discussion of therapeutic goals and management strategies.
Main Results:
- Pegylated interferons combined with ribavirin are becoming the standard of care.
- Sustained virologic response (SVR) is increasingly viewed as a cure for HCV.
- Predictive factors for SVR include non-genotype 1 viral strains, low viral load, absence of cirrhosis, younger age, female gender, and shorter infection duration.
Conclusions:
- Treatment decisions should consider disease severity, comorbidities, and contraindications.
- Patient counseling on transmission, natural history, and abstinence is crucial.
- Close monitoring for side effects of interferon (depression, bone marrow suppression) and ribavirin (hemolytic anemia) is necessary.
Abstract:
Infection with hepatitis C virus (HCV) accounts for 40% of cases of chronic liver disease in the United States and is now the most common indication for liver transplantation. Estimates suggest that 4 million people (1.8%) of the American population are or have been infected with HCV. Currently, the treatment of choice for patients with chronic HCV infection is recombinant interferon alfa with ribavirin. Pegylated interferons are a promising new development, and in combination with ribavirin, they will rapidly become the standard of care. The goals of therapy are to slow disease progression, improve hepatic histology, reduce infectivity, and reduce the risk of hepatocellular carcinoma. Sustained virologic response, which generally implies the absence of viremia for 6 months or more following completion of therapy, is increasingly being regarded as a cure, with evidence of slowing or even regression of fibrosis on follow-up liver biopsy. A number of factors have been shown to be predictive of a sustained response, including viral genotype other than 1, low serum HCV RNA levels, absence of cirrhosis, younger age, female gender, and shorter duration of infection. Disease severity as assessed by liver biopsy, comorbidities, and possible contraindications to therapy should be weighed in the decision to begin treatment. Counseling patients regarding transmission, natural history, and drug and alcohol abstinence also should be included in management. Close monitoring should be done during treatment for side effects of interferon, including depression and bone marrow suppression. Hemolytic anemia is the major side effect of ribavirin.