Audio;Recommendations Chronic Hepatitis C Infection;Case Vignette

Clinical Practice
Chronic Hepatitis C Infection
Hugo R. Rosen, M.D.
N Engl J Med 2011; 364:2429-2438
June 23, 2011
Comments open through June 29, 2011

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 45-year-old man undergoing a routine examination for life insurance is noted to have an aspartate aminotransferase level of 80 U per milliliter (normal range, 9 to 40) and an alanine aminotransferase level of 110 U per milliliter (normal range, 7 to 52). He reports a remote history of intravenous drug use. Tests for hepatitis C antibody and hepatitis B surface antibody are positive, and tests for hepatitis A and human immunodeficiency virus (HIV) antibodies are negative. Genotyping of the hepatitis C virus (HCV) reveals genotype 1b; the viral load is 2,460,000 IU per milliliter. The complete blood count is normal; the platelet count is 220×109 per liter. An abdominal ultrasonogram is normal. How should this patient's case be managed?

Read Complete Text/View All Figures/Tables @ The New England Journal Of Medicine
Strategies and Evidence
Diagnosis and Clinical Staging
Management
Interferon-Based Antiviral Therapy
Substantial progress has been made in the treatment of HCV infection. The goals of therapy are to prevent complications and death from HCV infection; regardless of the stage of fibrosis, symptomatic extrahepatic HCV (e.g., cryoglobulinemia) is an indication for therapy.2 Over the past decade, on the basis of considerable data from randomized trials, pegylated interferon (peginterferon) plus ribavirin became the standard of care for all HCV genotypes.24-26
Directly Acting Antiviral Agents
Boceprevir/Telaprevir
Areas of Uncertainty
Transient elastography (FibroScan, Echosens) is a novel noninvasive technique that measures liver stiffness by assessing the velocity of a shear wave created by a transitory vibration
Guidelines
Conclusions and Recommendations
An audio version of this article is available at NEJM.org.

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