[Diagnosis and treatment of chronic hepatitis C. Practical recommendations and new developments]

Chronic hepatitis C affects more than 500,000 people in Germany and is one of the most important chronic liver diseases. A large part of liver cirrhosis and cancer as well as most liver transplantations are today caused by hepatitis C.

The review analyzes the recent Medline-literature and own data about diagnosis and therapy of chronic hepatitis C with special emphasis on practical consequences of the new data.

In contrast to HBV, hepatitis C is usually not transmitted by sexual and perinatal means which leads to corresponding recommendations by official health care organizations. Diagnosis of chronic hepatitis C with antibody tests and HCV-RNA is today easy and reliable. HCV genotype and quantitative measurements of HCV-RNA should be done prior to antiviral therapy. Liver biopsy is necessary to determine the disease stage and the urgency for antiviral therapy. Young subjects with biochemical and histological inflammation should be treated. The standard therapy with pegylated interferon and ribavirin is able to eliminate HCV-RNA from serum in approximately 60% of the patients. In patients with genotype 1 and high virus load therapy can eliminate HCV-RNA in 30-40% while therapy is successful in > 90% of patients with genotype 3 and low virus load. There is increasing evidence that antiviral therapy causes beneficial effects on disease progression and cancer risk also in patients in whom HCV-RNA is not eliminated.