Diagnosis and treatment of chronic hepatitis C: Practical recommendations and new developments

Background: Chronic hepatitis C affects more than 500,000 people in Germany and is one of the most important chronic liver diseases. A large part of l iver cirrhosis and cancer as well as most liver transplantations are today caused by hepatitis C. Methods: The review analyzes the recent Medline-literature and own data abo ut diagnosis and therapy of chronic hepatitis C with special emphasis oil p ractical consequences of the new data. Results and Discussion: In contrast to HBV, hepatitis C is usually not tran smitted by sexual and perinatal means which leads to corresponding recommen dations by official health care organizations. Diagnosis of chronic hepatit is C with antibody tests and HCV-RNA is today easy and reliable. HCV genoty pe and quantitative measurements of HCV-RNA should be done prior to antivir al therapy. Liver biopsy is necessary to determine the disease stage and th e urgency for antiviral therapy. Young subjects with biochemical and histol ogical inflammation should be treated. The standard therapy with pegylated interferon and ribavirin is able to eliminate HCV-RNA from serum in approxi mately 60% of the patients. In patients with genotype I and high virus load therapy can eliminate HCV-RNA in 30-40% while therapy is successful in > 9 0% of patients with genotype 3 and low virus load. There is increasing evid ence that antiviral therapy causes beneficial effects on disease progressio n and cancer risk also in patients in whom HCV-RNA is not eliminated.