Hepatitis C Management

Ask The Experts

Question

The patient is a 47-year-old male who has been a hepatitis C carrier for 20 years. Post-transfusion, he is asymptomatic and has normal liver function tests. His physical examination is normal. Is he a candidate for interferon therapy?

Many individuals infected with HCV have normal liver enzymes. These individuals respond as well to pegylated interferon and ribavirin as those whose enzymes are elevated and are candidates for therapy.

Absent co-factors such as alcohol use, obesity, or iron overload, most of these individuals have little evidence of fibrosis on liver biopsy. There is genuine unresolved debate about the need or value of treating for HCV infection when the biopsy shows no fibrosis. When a liver biopsy shows fibrosis, even those with normal enzymes are at risk for advanced disease. And, of course, many of these individuals have additional risk factors such as alcohol use and obesity.

We recommend the following: Those with genotypes 2 or 3 should be offered treatment; those with other genotypes should have a liver biopsy before making decision. If there is more than stage 1 fibrosis, treatment should be considered. For those not treated, lifestyle modification including cessation of alcohol use and avoidance of obesity should be initiated.

Keep in mind that this patient is relatively young. If there is fibrosis, one would expect it to progress over the years.