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Interferon-α for Chronic Hepatitis C: Reducing the Uncertainties
- Raymond S. Koff, MD
- Columbia MetroWest Medical Center; Framingham, MA 01702 Requests for Reprints: Raymond S. Koff, MD, Department of Medicine, Columbia MetroWest Medical Center, 115 Lincoln Street, Framingham, MA 01702.
Acute hepatitis C virus (HCV) infection, recently ranked 10th among notifiable infectious diseases in the United States, is anticipated to affect approximately 30 000 persons in the United States in 1997 [1]. Yet, with nearly 4 million persons estimated to have persistent infection, the prevalence of chronic hepatitis C now exceeds that of alcoholic liver disease. Each year, as many as 12 000 deaths may be attributable to chronic HCV infection. The cumulative societal and health care cost burdens associated with this disease now loom large and are likely to increase dramatically during the next two decades as the population with the highest current prevalence of infection (persons 30 to 39 years of age) grows older and the disease progresses. Immunoprophylaxis of HCV infection will not be available soon; even if it were available, however, it would not alter this gloomy prediction. Only effective treatment of persons with established infection is likely to reduce the current and projected morbidity and mortality of chronic hepatitis C.
Unfortunately, knowledge of chronic hepatitis C and its sequelae is not yet complete, and highly effective therapy has not been available. The natural history of HCV infection is still uncertain. In fact, rates of progression of chronic hepatitis C to cirrhosis, end-stage liver disease, hepatocellular carcinoma, and death are not completely understood. Chronic hepatitis C seems to be an indolent, slowly progressive disease usually accompanied by little, if any, evidence of illness or death during the first two decades after infection. Progression is related to age at the time of infection; duration of infection; sex; concomitant alcohol use; and, possibly, the immunocompetence of the infected person. The degree of hepatic inflammation, as assessed by liver biopsy, may be a predictor of progression; the stage of hepatic fibrosis may be an even better predictor. The …
