Chronic Hepatitis C
Background: The hepatitis C virus (HCV) is the most common cause of chronic liver disease in the United States. Dramatic advances have been made recently in the treatment of this potentially life-threatening infection by using a combination interferon and ribavirin therapy.
Methods: The most common questions regarding chronic HCV infections that occur in the course of clinical practice of primary care physicians were elicited through e-mail and telephone interviews. To answer these questions, computerized literature searches of the MEDLINE database were performed and expert opinion was sought.
Results: For many patients with HCV who are treated with combination therapy, there is now a greater than 30% chance of achieving long-term normalization of transaminase levels and the loss of detectable viral load. Treatment is expensive, however, and can be difficult to tolerate. The effect of treatment on the risk of progression to liver failure and hepatocellular carcinoma is promising but has not yet been determined.
Conclusions: Primary care physicians play an important role in the diagnosis and initial workup of patients with HCV. By understanding the correct use of HCV diagnostic testing and the risks and benefits of antiviral therapy, providers will be better equipped to screen and counsel their patients infected with HCV.

Since the discovery of hepatitis C in 1989, a growing body of evidence has established the hepatitis virus (HCV) as the most common cause of chronic liver disease in the United States and one of the most common chronic infections of any kind encountered in the primary care setting. More than 2.7 million persons in the United States (or 1.3% of the population) are chronically infected with HCV, and many of these patients will go on to develop end-stage liver disease.

Rapid advances in the diagnosis and treatment of this often asymptomatic infection raise numerous questions for primary care physicians, who are responsible for diagnosing and counseling most patients with chronic HCV. This article will provide practical answers to some of these important questions.