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HCV infection should be managed in specialist centres
  1. G Dusheiko
  1. Royal Free and University College School of Medicine, London NW3 2QG, UK;

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Chronic hepatitis C virus (HCV) infection may cause slowly progressive chronic hepatitis, cirrhosis, advanced liver failure, and hepatocellular carcinoma.1 These varying outcomes of type C hepatitis pose a challenge and responsibility which requires firstly, that antiviral treatment is targeted as precisely as possible to those who have progressive disease, and secondly, that patients with advanced disease are managed by specialist centres with the capability of minimising the morbidity of the disease. Presently, most patients with community and hospital associated hepatitis C requiring treatment are referred to specialist liver centres.

The hepatologist has a pivotal role in the management of chronic hepatitis C. This includes the differential diagnosis, clinical management, and assessment of the stage of disease. Hepatology has become an increasingly specialised discipline and hepatologists are ideally placed to collate investigations and to ensure the appropriate management of coexisting liver disease. Specialist hepatologists also provide the continuity and follow up required for understanding the sometimes complex dynamic nature of the disease.

There is a unique requirement for the histopathological investigation of hepatitis C to inform and deliver the National Institute of Clinical Excellence (NICE) guidelines. Useful classifications for staging and grading of disease have been devised.2 There is a need for experienced clinical input to complement the interpretation of liver biopsies by histopathologists who …

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