Hepatitis Web Study

Initiating Treatment for Hepatitis C Virus Infection

Authors: David L. Thomas, MD

Last updated: May 15, 2006

A 46-year-old schoolteacher wants a second opinion about treatment of his hepatitis C virus (HCV) infection. He was diagnosed with hepatitis C in the late 1990s by antibody testing done because routine laboratory studies showed an alanine aminotransferase (ALT) level of 65 IU/L (range 8-35 IU/ml). He now brings laboratory slips showing testing over the ensuing six years as follows:

  • ALT levels between 32 and 74 IU/L
  • HCV RNA levels 6.1 log copies/ml, then more recently 5.4 IU/ml and 5.2 IU/ml
  • HCV genotype 1a
  • Liver biopsy done 6 months ago showing septate fibrosis (ranked stage 3 of 4 by Metavir scoring system) with mild portal and lobular inflammation
  • Serum creatinine 0.8 mg/dl
  • Albumin 4.6 mg/dl
  • Total bilirubin 0.8 mg/dl
  • Platelet count 134,000/mm3
  • Other ‘routine tests,’ including hematocrit and serum chemistries, normal.

The patient acknowledges some illicit drug use in late 1970s, but not since. He drinks “socially,” less now than when he was younger. He has been treated for depression with paroxetine (Paxil), but is not currently on treatment. He is taking no medications and is not aware of any other medical problems. He is married with two children. His review of systems is negative and his physical examination is normal.

Which of the following is the optimal approach regarding hepatitis C treatment for this patient?

A Check another noninvasive test for liver fibrosis, such as transient elastography or FibroSURE).
B Continue to monitor HCV RNA to see if the declining trend continues.
C Initiate a course that will consist of 48 weeks of peginterferon and ribavirin therapy.