[en] Infection with the hepatitis C virus (HCV) represents an important public health problem and is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma. Chronic hepatitis C is a heterogeneous disease. Many patients have mild disease at presentation but not all of them will develop advanced liver disease. However, the identification of these patients with mild hepatitis C who will show progressive disease is difficult and is based on histological criteria and the assessment of co-factors (age, alcohol intake, steatosis). In addition, serum transaminases that are persistently normal on several occasions during 18 months may point to a more benign course. Patients with mild hepatitis C should not be excluded "a priori" from the possibility of being treated, as treatment with pegylated interferon and ribavirin is safe and effective in this group. Overall, the decision to initiate therapy should be individualized and based on the severity of the disease by liver biopsy, the potential of serious side effects, the probability of response and the motivation of the patient.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Verslype, C.
Michielsen, P.
Adler, M.
Orlent, H.
Sprengers, D.
Delwaide, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Gastro-Entérologie-Hépatologie
National Institutes of Health Consensus Development Conference Statement: Management of Hepatitis C, 10-12 June 2002 (2002) Hepatology, 36, pp. S3-S20
Alberti, A., Benvegnù, L., Boccato, S., Ferrari, A., Sebastiani, G., Natural history of initially mild chronic hepatitis C (2004) Dig. Liver Dis., 36, pp. 646-654
Weissenborn, K., Krause, J., Bokemeyer, M., Hecker, H., Schuler, A., Ennen, J.C., Ahl, B., Boker, K.W., Hepatitis C virus infection affects the brain-evidence from psychometric studies and magnetic resonance spectroscopy (2004) J. Hepatol., 41, pp. 845-851
Alberti, A., Noventa, E., Benvegnù, L., Boccato, S., Gatta, A., Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection (2002) Ann. Intern. Med., 137, pp. 961-964
Kim, H.C., Nam, C.M., Jee, S.H., Han, K.H., Oh, D.K., Suh, I., Normal serum aminotransferase concentration and risk of mortality from liver diseases: Prospective cohort study (2004) Br. Med. J., 328, p. 983
Prati, D., Taioli, E., Zanella, A., Della Torre, E., Butelli, S., De Vecchio, E., Vianello, L., Sirchia, G., Updated definitions of healthy ranges for serum alanine aminotransferase levels (2002) Ann. Intern. Med., 137, pp. 1-10
Alberti, A., Towards more individualised management of hepatitis C virus patients with initially or persistently normal alanineaminotransferase levels (2005) J. Hepatol., 42, pp. 266-274
Zeuzem, S., Diago, M., Gane, E., Reddy, K.R., Pockros, P., Prati, D., Shiffman, M., Lardelli, P., Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels (2004) Gastroenterology, 127, pp. 1724-1732
Rossi, E., Adams, L., Prins, A., Bulsara, M., De Boer, B., Garas, G., Macquillan, G., Jeffrey, G., Validation of the FibroTest biochemical markers score in assessing liver fibrosis in hepatitis C patients (2003) Clin. Chem., 49, pp. 450-454
Callewaert, N., Van Vlierberghe, H., Van Hecke, A., Laroy, W., Delanghe, J., Contreras, R., Noninvasive diagnosis of liver cirrhosis using DNA sequencer-based total serum protein glycomics (2004) Nat. Med., 10, pp. 429-434
Strader, D.B., Wright, T., Thomas, D.L., Seeff, L.B., Diagnosis, management and treatment of hepatitis C (2004) Hepatology, 39, pp. 1147-1171
Marcellin, P., Asselah, T., Boyer, N., Fibrosis and disease progression in hepatitis C (2002) Hepatology, 36, pp. S47-S56
Ghany, M.G., Kleiner, D.E., Alter, H., Doo, E., Khokar, F., Promrat, K., Herion, D., Hoofnagle, J.H., Progression of fibrosis in chronic hepatitis C (2003) Gastroenterology, 124, pp. 97-104
Hui, C.K., Belaye, T., Montegrande, K., Wright, T.L., A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase (2003) J. Hepatol., 38, pp. 511-517
Salomon, J.A., Weinstein, M.C., Hammitt, J.K., Goldie, S.J., Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population (2003) J. Am. Med. Assoc., 290, pp. 228-237
Manns, M.P., Mchutchison, J.G., Gordon, S.C., Rustgi, V.K., Shiffman, M., Reindollar, R., Goodman, Z.D., Albrecht, J.K., Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomized trial (2001) Lancet, 358, pp. 958-965
Fried, M.W., Shiffman, M.L., Reddy, K.R., Smith, C., Marinos, G., Goncales Jr., F.R., Haussinger, D., Yu, J., Combination of peginterferon alfa-2a plus ribavirin in patients with chronic hepatitis C virus infection (2002) N. Engl. J. Med., 347, pp. 975-982
Annemans, L., Warie, H., Nechelput, M., Peraux, B., A health economic model to assess the long term effects and cost-effectiveness of PEG IFN α-2a in hepatitis C virus infected patients (2004) Acta Gastroenterol. Belg., 67, pp. 1-8
Michielsen, P., Brenard, R., Bourgeois, N., De Galocsy, C.H., Delwaide, J., Henrion, J., Horsmans, Y., Van Vlierberghe, H., Hepatitis C: Screening, treatment and prevention practical guidelines (2003) Acta Gastroenterol. Belg., 66, pp. 15-19
Grieve, R., Roberts, J., Wright, M., Sweeting, M., Deangelis, D., Rosenberg, W., Bassendine, M., Thomas, H., Cost-effectiveness of interferon α or peginterferon β, with ribavirin for histologically mild chronic hepatitis C (2005) Gut, , Epub June 30, 2005