Hepatitis C Management

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Question

A patient was diagnosed with hepatitis C in 1981. In 2000, he was treated with interferon three times weekly and ribavirin daily with excellent results. In 2008, his RNA counts are less than 10 IU/mL. What should the liver enzyme values be?

This is a complex question with no clear answer. In theory, all treatment-naive patients should be considered for therapy. However, because of limitations of treatment and the significant costs and side effects, not all patients are candidates for treatment. Current treatment guidelines suggest treating patients who are treatment-naive, have persistently elevated aminotransferase levels, and whose liver biopsies show fibrosis or at least moderate necrosis and inflammation.

Comorbidities and advanced liver disease can complicate the situation and should be addressed on a case-by-case basis.

Patients who were previously treated with standard interferon or who were inadequately treated with pegylated interferon may be reconsidered for treatment with pegylated interferon and ribavirin. These patients should be assessed on an individual basis.

For more information, see the section on combination interferon and ribavirin in the Hepatitis C Management monograph.