The recent National Institutes of Health (NIH) Consensus Development Conference helped to clarify which patients should be treated. The Consensus Statement began by noting that all patients with chronic hepatitis C were to be considered as potential candidates for antiviral therapy. Treatment was particularly recommended for those patients at increased risk of developing cirrhosis.
The Consensus Statement further charac-terized them as having detectable HCV RNA, a liver biopsy with portal or bridging fibrosis and at least moderate inflam-mation and necrosis. The majority of these patients would be expected to have elevated serum aminotransferase activities.
For patients with milder forms of liver disease or persistently normal serum alanine aminotransferases (ALTs), it was noted that there were differences of opinion about treatment. Certainly, patients with normal ALTs appear to have similar rates of SVR compared to those with elevated ALTs and they can be treated on an individual basis, taking into account factors such as favor-able genotype, presence of hepatic fibrosis, patient motivation, symptoms, age and presence and severity of comorbid illnesses.
If patients are not subjected to antiviral therapy, they should be monitored periodically to identify progression of their liver disease promptly. Patients with advanced liver disease in the form of hepatic decompensation or after liver transplantation should not be treated routinely, although therapy could be considered in the context of clinical trials or by experts with experience in these conditions.
Some patients have been previously excluded from therapy because of behavioral problems such as alcohol or drug abuse and comorbid medical and psychiatric conditions. The Consensus Statement recommended that 'efforts should be made to increase the availability of the best current treatments to these patients'.
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