Management of hepatitis C

Hepatitis C (HCV) infection is the most common cause of liver disease seen in clinical practice. The usual mode of acquisition of HCV is by blood, and HCV is most often seen in persons with a history of injection drug use or who received a transfusion prior to 1991 (when testing of the blood supply for HCV was introduced). Only 25% of those infected will clear the virus; the majority of patients progress to chronic infection. Many chronically infected patients remain asymptomatic for years, and it is only after decades that some patients present with clinically apparent liver disease. HCV infection is diagnosed by the detection of an antibody to HCV and confirmed by the demonsration of viremia. Liver biopsy is usually recommended to assess severity of liver damage. Treatment with pegylated interferon in combination with ribavirin results in sustained eradication of HCV in more than half the cases treated. Treatment is often limited by significant side effects. Newer treatment modalities are in clinical trials.