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British Medical Bulletin 2004 70(1):51-69; doi:10.1093/bmb/ldh022
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Published online 4 October 2004

British Medical Bulletin, Vol. 70 © The British Council 2004; all rights reserved

Management of hepatitis C

Marcus Teo and Peter Hayes

Gastrointestinal and Liver Diseases Department, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SU, UK

Correspondence to: Marcus Teo, 79 Shakespeare Avenue, Magill, S.A. 5072, Australia. Email: mjteo{at}bigpond.com

Hepatitis C virus (HCV) infection is a common cause of chronic liver disease and hepatocellular carcinoma. It is estimated that 15–20% of those infected will develop cirrhosis after 20 years of infection. It is transmitted parenterally, and HCV antibody and HCV RNA tests diagnose infection with a high degree of accuracy. Currently, a combination of peginterferon and ribavirin is the most efficacious treatment, with sustained viral response rates of 45% for genotype 1 and 80% for genotypes 2 and 3. There is some evidence that treatment with interferon-based regimens can improve the natural history of this infection. The side effects of treatment are well recognized and include leucopenia, thrombocytopenia, haemolytic anaemia and depression. Patients with HCV-related decompensated cirrhosis and/or hepatocellular carcinoma should be considered for liver transplantation. The management of special groups, including those with acute HCV infection, co-infected with hepatitis B (HBV) or human immunodeficiency virus (HIV), continues to be defined.


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