Management of hepatitis C: current and future perspectives.

Chronic hepatitis C is now a major cause of chronic liver disease, cirrhosis and hepatocellular carcinoma. In March 1997, the National Institutes of Health sponsored a Consensus Development Conference entitled "Management of Hepatitis C". The final statement from the Consensus Panel set forth clear, evidence-based guidelines and recommendations regarding the diagnosis, evaluation, prevention and therapy of hepatitis C. The conclusions of the Consensus Panel have been widely accepted and have brought some degree of uniformity to the management of hepatitis C. An important issue is how to keep such recommendations current in such a rapidly evolving area of medicine. In the 2 years since the Consensus Conference there have been important advances in the management of chronic hepatitis C. Two recommendations of the Consensus Panel deserve modification: first, on the clinical usefulness of genotyping of hepatitis C virus and second, on the optimal therapeutic regimen. Two large multicenter, prospective controlled trials have shown that the combination of alpha interferon with ribavirin provides higher sustained virologic responses than interferon alone and that optimal therapy is a 24-week course for patients with genotypes 2 and 3 and a 48-week course for patients with genotype 1. Furthermore, therapy can be stopped at 24 weeks if HCV RNA is still present. Many clinical challenges remain. Major current needs are for accurate means of assessing the grade and stage of disease, for the likelihood of disease progression and of response to therapy as well as for viral eradication by treatment. Also important are new therapies for hepatitis C that might be used alone or in combination with interferon and ribavirin; therapies that could be applied to a wide variety of patients, with different stages of disease and with other comorbitities.