Hepatitis C, fatty liver disease, and hepatic drug toxicity are the most common liver problems seen by primary care physicians and other health care providers. Hepatitis C virus (HCV) infection is the most common chronic blood-borne viral infection in North America. An estimated 3.9 million persons have been exposed, and 2.7 million have measurable levels of viral RNA. An estimated 38,000 are newly infected annually. More than 5% of certain groups are infected.1 Although the natural history is often benign, over time 20% will develop a serious sequela, such as severe fibrosis, cirrhosis, end-stage liver disease, or hepatoma. Some will have an extrahepatic manifestation, such as lichen planus, leukocytoplastic vasculitis, membranoproliferative glomerulonephritis, porphyria cutanea tarda, or B-cell lymphoma.
The substantial morbidity, mortality, and economic burden associated with HCV infection are responsible for the striking worldwide public health impact of this condition. Currently, HCV infection is responsible for an estimated 8,000 to 10,000 deaths annually in the United States, and that number is predicted to triple in the next 10 to 20 years. HCV-related disease is the leading indication for liver transplantation in the United States. The decision to treat patients with chronic HCV infection should be made after many factors have been considered and each case has been individualized.
It is important for all health care practitioners to understand effective strategies to establish or exclude a diagnosis of HCV infection and to interpret tests correctly. Effective treatment rests importantly on recognition of the attributes that influence disease progression; they include host factors such as age, obesity, comorbidities (eg, chronic renal failure, coinfection with human immunodeficiency virus [HIV]), and others. Viral properties such as genotype play an important role in treatment choices and outcomes. A thorough understanding of the pharmacology and pharmacodynamics of the agents used in treatment and management of side effects is also important.