Chronic Hepatitis C Infection

Rosen, Hugo R. M.D.

From the Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, and Eastern Colorado Veterans Affairs Medical Center, Denver.

Address reprint requests to Dr. Rosen at the Division of Gastroenterology and Hepatology, University of Colorado, Denver, B-158 Academic Office Bldg. 1, 12631 E. 17th Ave., Rm. 7614, Aurora, CO 80045, or at [email protected].

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

An audio version of this article is available at NEJM.org.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

No potential conflict of interest relevant to this article was reported.

I thank Greg Everson, M.D., and Jean-Michel Pawlotsky, M.D., Ph.D., for discussions and review of an earlier version of the manuscript.

New England Journal of Medicine 364(25):p 2429-2438, June 23, 2011.

A 45-year-old man undergoing a routine examination for life insurance is noted to have an aspartate aminotransferase level of 80 U per milliliter (normal range, 9 to 40) and an alanine aminotransferase level of 110 U per milliliter (normal range, 7 to 52). He reports a remote history of intravenous drug use. Tests for hepatitis C antibody and hepatitis B surface antibody are positive, and tests for hepatitis A and human immunodeficiency virus (HIV) antibodies are negative. Genotyping of the hepatitis C virus (HCV) reveals genotype 1b; the viral load is 2,460,000 IU per milliliter. The complete blood count is normal; the platelet count is 220×10⁹ per liter. An abdominal ultrasonogram is normal. How should this patient's case be managed?