Hepatitis C (cont.)

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Who should receive antiviral therapy for hepatitis C virus infection?

Current treatment options are imperfect (see below). Patients with HCV infection should discuss treatment options with a physician who is experienced in treating the disease. Treatment is recommended in patients at increased risk for cirrhosis unless there are reasons that would make treatment unsafe. According to the National Institutes of Health (NIH) persons at increased risk for cirrhosis would include those with HCV infection and:

  • Persistent elevation of ALT (alanine aminotransferase, a liver enzyme in the blood)
  • High levels of HCV RNA in the blood
  • Evidence of early fibrosis (scarring) or moderate inflammation and injury of liver cells on liver biopsy

The NIH also recommends treatment for patients who are co-infected with HCV and HIV, because these patients have a more rapid course of liver injury.

These are general guidelines. Patients and providers may decide that treatment is needed for other reasons. For example, HCV infection may cause cryoglobulinemia. (See above.) Persistent cryoglobulinemia may be a reason for treating hepatitis C. Newer therapies may be offered to selected patients in research settings.

Individuals who should not be treated with antiviral therapy include those who are unable to comply with the treatment schedule, have reasons that may make treatment unsafe (for example, allergy to the medications), have received a solid organ transplant, are pregnant or unwilling to practice adequate contraception during treatment, or who have reversible serious untreated conditions such as unstable heart disease, uncontrolled high blood pressure, or untreated major depression.

Patients with unstable (decompensated) cirrhosis are at high risk for complications for treatment and usually do not receive medical treatment except in research settings. Fundamentally, the decision regarding antiviral therapy in chronic HCV infection should be tailored to the individual patient with careful consideration of the risks and benefits.

All patients with HCV should be vaccinated against hepatitis B and hepatitis A. They also should be counseled on measures to prevent the spread of HCV and eliminating alcohol use. Finally, risk behaviors for HCV overlap with those of HIV, and all patients with HCV should be tested for HIV.

Medically Reviewed by a Doctor on 2/2/2014

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