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Treatment for Hepatitis C Virus Infection in Adults: Comparative Effectiveness

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Background: Complications Associated With Chronic Hepatitis C Virus Infection

Chronic hepatitis C virus (HCV) infection is a leading cause of complications from chronic liver disease, including cirrhosis, liver failure, and hepatocellular cancer. Chronic HCV infection has a variable course; in some patients disease progression to cirrhosis is slow, and complications related to chronic HCV infection frequently occur only after decades of infection. In other patients, disease progression is more rapid. Factors suggested to be related to rapid progression to cirrhosis include older age, obesity, immunosuppression (e.g., HIV coinfection), and consumption of large quantities of alcohol (>50 g of alcohol per day). The risk of developing cirrhosis ranges from 5 to 25 percent over a period of 25 to 30 years.

Identifying individuals at risk for developing progressive HCV-related disease is challenging. The currently preferred approach is to assess the degree of fibrosis by means of a liver biopsy, using a validated staging system such as the Ishak, IASL, Metavir, or Batts-Ludwig staging systems. However, staging systems for fibrosis and indications for liver biopsy continue to evolve. Other strategies, including blood tests and indices, are available and have been examined as alternatives.