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Treating Histologically Mild Chronic Hepatitis C: Monotherapy, Combination Therapy, or Tincture of Time?

Robert A. Levine, MD
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From the State University of New York Health Science Center at Syracuse, Syracuse, New York. For the current author address, see end of text. Acknowledgments: The author thanks Drs. Herbert L. Bonkovsky and Michael W. Fried for helpful suggestions. Requests for Reprints: Robert A. Levine, MD, Department of Medicine, Division of Gastroenterology, University Hospital, 750 East Adams Street, Syracuse, NY 13210.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(4):323-326. doi:10.7326/0003-4819-129-4-199808150-00010
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The recent National Institutes of Health Consensus Conference on hepatitis C solidified the justification for a selective approach to treatment.Nevertheless, the high profile of chronic hepatitis C has led to a sense of urgency about treating “all-comers” and thus has caused the variable natural history of this disease to be overlooked. The debate about whom to treat has failed to focus attention on the alternative approach of waiting for better emerging therapies for the subset of patients with histologically mild chronic hepatitis C. Practitioners should be more confident about postponing treatment in less symptomatic patients if liver biopsy specimens show no more than grade 1 necroinflammatory activity or stage 1 fibrosis. Patients with these lesions, in the absence of clinical signs of advancing disease, are much less likely than patients with higher grades or stages to progress to cirrhosis.

A “cure” for chronic hepatitis C remains elusive.End points of treatment depend on the achievement of sustained clearance of serum hepatitis C virus RNA, which is influenced, in turn, by the patient's viral replication and immune balance. Treatment of histologically mild chronic hepatitis C may ultimately mimic that of HIV infection.





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