Pretreatment Considerations for Chronic Hepatitis C Virus Infection

Authors: David L. Thomas, MD, MPH H. Nina Kim, MD, MSc

Last updated: August 14, 2012

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 log 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 g/dL
  • Total bilirubin 0.8 mg/dL
  • Platelet count 134 x 109/L
  • Other ‘routine tests,’ including hematocrit and serum chemistries, normal.

The patient acknowledges some illicit drug use in late 1970s, but not since. He used to drink alcohol but stopped drinking 10 years ago. He has been treated in the distant past for depression with paroxetine (Paxil), but is not currently on treatment and he has no symptoms of depression. 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 statements is TRUE regarding the decision to start hepatitis C treatment for this patient?

A Before starting therapy, it is essential to update the patient's liver fibrosis status by performing a noninvasive test for liver fibrosis, such as transient elastography.
B The patient's baseline HCV RNA level is the best predictor of treatment response.
C The degree of hepatic fibrosis correlates with treatment response.
C Monitoring serum aminotransferase levels plays a critical role in determining disease progression.