Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

The NIH "Consensus Statement on Management of Hepatitis C" was based on data available in March 1997 ⁽¹³³⁾. Because of advances in the field of antiviral therapy for chronic hepatitis C, standards of practice might change, and readers should consult with specialists knowledgeable in this area.

Persons Recommended for Treatment

Treatment is recommended for patients with chronic hepatitis C who are at greatest risk for progression to cirrhosis, as characterized by

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• persistently elevated ALT levels;

• detectable HCV RNA; and

• a liver biopsy indicating either portal or bridging fibrosis or at least moderate degrees of inflammation and necrosis.

Persons for Whom Treatment Is Unclear

Included are

• patients with compensated cirrhosis (without jaundice, ascites, variceal hemorrhage, or encephalopathy);

• patients with persistent ALT elevations, but with less severe histologic changes (i.e., no fibrosis and minimal necroinflammatory changes) (In these patients, progression to cirrhosis is likely to be slow, if at all; therefore, observation and serial measurements of ALT and liver biopsy every 3-5 years is an acceptable alternative to treatment with interferon); and

• patients aged <18 years or >60 years (note that interferon is not approved for patients aged <18 years).

Persons for Whom Treatment Is Not Recommended

Included are

• patients with persistently normal ALT values;

• patients with advanced cirrhosis who might be at risk for decompensation with therapy;

• patients who are currently drinking excessive amounts of alcohol or who are injecting illegal drugs (treatment should be delayed until these behaviors have been discontinued for >6 months); and

• persons with major depressive illness, cytopenias, hyperthyroidism, renal transplantation, evidence of autoimmune disease, or who are pregnant.