Chronic Hepatitis C Infection: Clinical and Societal Evaluations

Chronic hepatitis C virus infection (HCV) affects 180 million people worldwide. Chronic HCV can cause hepatic decompensation, hepatocellular carcinoma (HCC), and portal hypertension1. Nowadays, chronic HCV is the leading indication for liver transplantation in developed countries. HCV is an enveloped single-stranded RNA virus that is transmitted in humans through blood-to-blood contact2. Acute infection leads to chronic infection in 50-80%3. In most cases, chronic HCV infection remains relatively asymptomatic until complications of disease present. Natural course of chronic HCV infection is highly variable with serious liver disease developing in one third of persons 20 years or less after infection and no progression in another third for 30 years or longer. Factors that accelerate clinical progression include alcohol intake, which has a pronounced effect on the course of the disease, co-infection with HIV or HBV, male sex, and older age at infection. Once cirrhosis is established, the risk of HCC is approximately one to four percent per year. HCC can occur without cirrhosis but is rare. For this reason, antiviral treatment is ideally provided in pre-cirrhotic liver disease. Furthermore, antiviral treatment is more effective in non-cirrhotic and, preferably less fibrotic stages of chronic HCV infection.

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