National institutes of health consensus development conference: Management of hepatitis C: 2002

en-I titled "Management of Hepatitis C." The proceedings of that conference and the final Consensus Statement were published in Hepatologl and have had a major influence on clinical practice and approach to this disease. That conference was prompted by the uncertainty and confusion that surrounded the issues of the natural history, diagnosis, management, and particularly treatment of hepatitis C. At the time, the only available treatment for hepatitis C was monotherapy with interferon alfa. Overall, response rates to 24and 48-week courses of interferon were poor, adverse reactions were common, and costs were high. The Consensus Panel formulated recommendations based on the best available medical evidence and concluded that treatment should be offered to adult patients, ages 18 to 60 years, with chronic hepatitis C and the presence of hepatitis C virus (HCV) RNA in serum, persistently elevated alanine aminotransferase (ALT) activities, and a liver biopsy showing either portal or bridging fibrosis and at least moderate degrees of inflammation and necrosis. Despite the paucity of information, the Panel also recommended treatment of persons with acute hepatitis C and of persons with HCV-human immunodeficiency virus (HIV) coinfection provided they had a good clinical and functional status. The Panel further concluded that indications for therapy were less obvious for persons with histologically mild disease, for persons with compensated cirrhosis, and for children and the elderly. Finally, the Panel recommended that treatment should not be offered to patients with normal ALT values, patients with decompensated cirrhosis, and persons who drank "significant amounts of alcohol or who are actively using illicit drugs" until their habit had been discontinued for at least 6 months.