MANAGEMENT OF CHRONIC HEPATITIS-C - CLINICAL AUDIT OF BIOPSY BASED MANAGEMENT ALGORITHM

Objective: To assess the attendance, outcome, compliance with treatmen t, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy base d algorithm. Design: Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year. Setting: The l iver unit at a London teaching hospital. Subjects: 255 patients with c hronic hepatitis C. Main outcome measures: Patient survival, attendanc e, and compliance with diagnostic and therapeutic regimens. Response t o interferon alfa treatment, based on loss of viraemia three months af ter cessation of treatment. Results: A large proportion of patients (3 9%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for fur ther treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rat e to interferon (21%) in treated patients was similar to that previous ly reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amount ing to cirrhosis. In patients with cirrhosis there was a high incidenc e of hepatocellular carcinoma (18%) over a follow up period of 20 mont hs. Conclusion: Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large propo rtion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to dea l with this problem are urgently required.