[Hepatitis C: who should be treated?].

Area of Science:

• Hepatology
• Virology
• Internal Medicine

Background:

• Hepatitis C virus (HCV) infection poses significant global health challenges.
• Treatment decisions for HCV require careful consideration of patient-specific factors and disease stage.

Purpose of the Study:

• To delineate the recommended and contraindicated patient populations for antiviral therapy in Hepatitis C.
• To provide guidance on managing HCV in complex cases, including co-infections and specific comorbidities.

Main Methods:

• Review of clinical guidelines and evidence for Hepatitis C treatment recommendations.
• Analysis of patient subgroups based on disease activity (ALT levels), fibrosis stage (METAVIR score), treatment history, and comorbidities.

Main Results:

• Strong recommendations for therapy in acute infection, elevated ALT, F ≥ 2 METAVIR score, nonresponders/relapsers to triple therapy, compensated cirrhosis, and hemodialysis patients.
• Treatment is feasible for HBV/HIV co-infection, severe extrahepatic manifestations, liver transplant recipients, and post-abstinence drug/alcohol users.
• Contraindications include fulminant hepatitis, persistent normal ALT without fibrosis, kidney transplant recipients, and pregnant women.

Conclusions:

• Antiviral therapy for Hepatitis C is highly individualized, with clear indications and contraindications.
• Careful patient selection ensures optimal outcomes and avoids potential adverse events.