Treatment of hepatitis C. The 2002 French consensus
- 1Department of Hepatology and Gastroenterology, Henri Mondor Hospital, Créteil, France
- 2Department of Hepatology, Beaujon Hospital, Clichy, France
- 3Department of Gastroenterology, Charles Nicolle Hospital, Rouen, France
- Correspondence to:
Professor D Dhumeaux
Department of Hepatology and Gastroenterology, Henri Mondor Hospital, 51 av du Mal, de Lattre de Tassigny, Créteil 94000, France;
- Accepted 16 April 2003
Chronic infection by hepatitis C virus (HCV) affects 170 million people worldwide. In European countries the overall prevalence in adults ranges from 1% to 2%,1,2 and more than five million Europeans are thus infected. The high prevalence of HCV infection, together with the risk of severe complications which include cirrhosis and hepatocellular carcinoma,3,4 makes this a major public health problem.
HCV was discovered more than 10 years ago, and considerable progress has since been made in our knowledge of the virus, its modes of transmission, the natural history of the infection, and also patient management, including specific therapy. Several consensus conferences have been organised in the last five years, in particular the French Association for the Study of the Liver in January 1997,5 the National Institutes of Health in March 1997,6 and the European Association for the Study of the Liver (EASL) in February 1999.7 Major changes have since occurred in the epidemiology of the infection and in patient management.
Firstly, recent surveys show profound changes in the characteristics of newly diagnosed patients: the proportion of patients with mild chronic hepatitis at diagnosis has increased, and the absolute number of severe cases—that is, with cirrhosis and hepatocellular carcinoma—has also increased,8,9 a large proportion of patients having been infected several decades previously. The modes of HCV transmission have also evolved, with a gradual reduction in the proportion of cases related to transfusion and an increase in the proportion related to intravenous drug use. These changes largely account for the observed changes in the HCV genotype profile, characterised by an increase in the prevalence of genotype 3 infection, which is associated with a better response to treatment.
Secondly, since the 1999 EASL consensus conference, new advances have been made in the …