Hepatitis C virus infection: Diagnosis, natural course and therapy

The hepatitis C virus is a 9.4-kb single-stranded positive RNA virus. After infection, more than 80% of patients develop a chronic carrier state. The diagnosis is based on the detection of hepatitis C virus antibodies and of HCV RNA. Recently, methods have been established to quantify HCV RNA levels and determine HCV genotypes. Interferon treatment gives long-term response in 10-20% of individuals. Low transaminase levels, low levels of viremia and low histological activity are positive predictive parameters for treatment response. In contrast, cirrhosis, high ferritin levels and associated markers of autoimmunity are negative predictors of treatment response. At present, the combination of interferon with the nucleoside analogue ribavirin is being evaluated. Endstages of hepatitis-C-induced cirrhosis are treated with liver transplantation. Reinfection of the graft occurs regularly, the clinical implications of which are not yet clear. Our knowledge of the spontaneous course and treatment response of hepatitis C infection in hemodialysis patients is limited.