Success in treating mild chronic hepatitis C: different outcomes - new guidelines?

Rosenberg, William M.C. (2002) Success in treating mild chronic hepatitis C: different outcomes - new guidelines? European Journal of Gastroenterology & Hepatology, 14 (6), 595-597.

Abstract

* Mild chronic hepatitis C is thought to rarely result in liver related death.
* Drug treatments for chronic hepatitis C are thought to be toxic and costly.
* The results of early treatment trials in chronic hepatitis C were disappointing.
* Existing guidelines fail to recommend antiviral treatment in mild hepatitis C.
* Improved treatment responses and recognition of non-liver related morbidity require review of treatment recommendations for mild chronic hepatitis C.
Limited knowledge of the natural history of chronic hepatitis C suggests that patients with mild histological changes on liver biopsy are at low risk of developing liver related morbidity or mortality. Patients with mild disease have been excluded from the large trials of treatment for hepatitis C and consequently guidelines recommend that they are excluded from treatment. However, as the probability of a beneficial response to treatment increases with improvements in antiviral therapy so the threshold for treatment falls. Trials reporting good responses to treatment in patients with mild disease support the case for widening access to treatment. Increasing recognition that chronic hepatitis C infection can lead to impairment of quality of life that is independent of liver histology is likely to result in more patients with mild hepatitis seeking treatment, more clinical trials that include patients with milder stages of liver disease, and greater enthusiasm for their inclusion in treatment guidelines.

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