Antiviral Treatment for Hepatitis C Cirrhosis: Is the Effort Justified?

Cirrhosis resulting from chronic hepatitis C virus (HCV) infection occurs in 20% to 40% of infected individuals. Chronic HCV infection is the most common cause of cirrhosis in the United States (1) and is the most common diagnosis that leads to liver transplantation, and in many parts of the world, it is the leading disease associated with hepatocellular carcinoma (2). The prevalence of hepatitis C in the U.S. population has been estimated at 1.8% (3). This estimate, derived from NHANES III (Third National Health and Nutrition Examination Survey) data obtained from 1988 to 1994, is conservative; NHANES excluded incarcerated and homeless persons, groups that have high rates of HCV infection, and tested only a single sample for each participant. Furthermore, ongoing immigration of persons from countries with a high prevalence of hepatitis C continually swells the numbers of people with hepatitis C in the United States.

Most persons infected with hepatitis C are asymptomatic until they present with advanced disease after a 20- to 30-year silent period of chronic infection. Although some groups champion widespread screening for HCV infection (4), others actively discourage screening all persons at average risk for HCV infection (5). Regardless, clinicians do diagnose HCV infections and must make therapeutic decisions about treating these infections in asymptomatic persons.

A variety of treatments are available. Natural interferon can eradicate virus, and a combination …