Jules L. Dienstag – 10 February 2006 – The report of the 1997 National Institutes of Health Consensus Development Conference on hepatitis C endorsed pretreatment liver biopsy. We revisit the following questions: Does liver histology help determine the urgency of, and predict the likelihood of response to, antiviral therapy, and can surrogate markers supplant histological assessment?
Miriam J. Alter – 10 February 2006 – Hepatitis C virus (HCV) is transmitted by percutaneous or permucosal exposure to infectious blood or blood‐derived body fluids.
Patrick Marcellin, Tarik Asselah, Nathalie Boyer – 10 February 2006 – The progression of fibrosis in chronic hepatitis C determines the ultimate prognosis and thus the need and urgency of therapy. Fibrogenesis is a complex dynamic process, which is mediated by necroinflammation and activation of stellate cells. The liver biopsy remains the gold standard to assess fibrosis. Scoring systems allow a semiquantitative assessment and are useful for cross‐sectional and cohort studies and in treatment trials. The rate at which fibrosis progresses varies markedly between patients.
Michael W. Fried – 10 February 2006 – Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well‐described side effects that are dominated by fatigue, influenza‐like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa‐2a and alfa‐2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation.
David L. Thomas – 10 February 2006 – In the United States, an estimated 200,000 persons are infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV). As the lives of HIV‐infected persons have been prolonged by use of highly active antiretroviral therapy, liver disease has emerged as an important, and in some settings, the leading cause of morbidity and mortality. Human immunodeficiency virus infection appears to adversely affect all stages of hepatitis C infection, leading to increased viral persistence and accelerated progression of HCV‐related liver disease.
Jay H. Hoofnagle – 10 February 2006 – The hepatitis C virus (HCV) is a small enveloped RNA virus belonging to the family flaviviridae and genus hepacivirus. The HCV RNA genome is 9,600 nucleotides in length and encodes a single polyprotein that is post‐translationally cleaved into 10 polypeptides including t3 structural (C, E1, and E2) and multiple nonstructural proteins ([NS] NS2 to NS5). The NS proteins include enzymes necessary for protein processing (proteases) and viral replication (RNA polymerase).
Doris B. Strader – 10 February 2006 – Managing patients with hepatitis C virus (HCV) infection consists primarily of antiviral treatment, currently with peginterferon and ribavirin. Unfortunately, treatment recommendations derive largely from trials that have focused on highly selected patient populations. As a consequence of the strict inclusion and exclusion criteria in these studies, more than half of all HCV‐infected patients would be ineligible for enrollment. Even among the selected patients enrolled into studies, only 50% achieve a sustained virological response (SVR).
Jean‐Michel Pawlotsky – 10 February 2006 – Four virological markers of hepatitis C virus (HCV) infection are used clinically for management of patients with hepatitis C, namely the HCV genotype, HCV RNA, HCV core antigen, and antibody to HCV (anti‐HCV). The diagnosis of acute and chronic hepatitis C is based on both anti‐HCV detection using enzyme immunoassays (EIA) and HCV RNA detection using a sensitive molecular biology‐based technique.