Hepatitis C: Good candidates for treatment


Topic: Hepatitis C, June 2000

Dr. Lee:
Dr. Block, who are good candidates for treatment of Hepatitis C?

Dr. Edward Block:
That is somewhat a difficult question to answer because anyone who tests positive for hepatitis C antibody should be evaluated for treatment.

Generally patients found to have positive hepatitis C antibody will be tested for hepatitis C RNA (HCV RNA). A positive hepatitis C RNA test indicates active infection with hepatitis C virus. Then treatment is generally considered.

But there are additional factors to be considered. A patient's age is a factor. Since hepatitis C is a very slowly progressive disease, there are certain elderly people where treatment may not be appropriate.

It is also important to determine the duration of the disease. If the patient has the disease over 30 or 40 years, it may be wise to determine just how much liver damage has occurred by a liver biopsy before considering treatment. A liver biopsy not only shows us how much scarring and inflammation (chronic hepatitis) is in the liver, it is also a good tool for prognosticating (trying to predict) who is going to do well and who is going to develop progressive liver damage.

In the presence of active liver inflammation and/or scarring, most people would be candidates for treatment, unless there are strong reasons not to treat.

If liver biopsy is normal or shows minimal inflammation without any scarring after 30-40 years of HCV infection, some doctors may choose to monitor the patient without treatment.

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