Chronic hepatitis C: Latest diagnosis and treatment guidelines

Although the number of new hepatitis C virus (HCV) infections has dropped dramatically during the past 15 years, millions of Americans remain infected and at risk for fatal liver disease. Persons who require testing include health care workers with needlestick injuries and children born to HCV-infected woman. Consider testing patients who have injected illicit drugs, received clotting factor concentrates before 1987 or blood transfusions or organ transplants before July 1992, undergone long-term hemodialysis, had unexplained increases in alanine aminotransferase or aspartate aminotransferase levels, or who are infected with HIV. Liver biopsy remains the best method of assessing disease severity. Combination therapy with pegylated interferon alfa and ribavirin produces a sustained viral response rate of about 50% of patients with genotype 1 disease and more than 75% of those with genotype 2 or 3 infection. Therapy is associated with serious side effects and must be carefully monitored.