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Man With Hepatitis C Infection: Making Treatment Decisions

Man With Hepatitis C Infection: Making Treatment Decisions

PATIENT PROFILE
Infection with hepatitis C virus (HCV) was recently diagnosed
in a 45-year-old man when a positive enzyme-linked immunosorbent
assay was followed by a polymerase chain reaction assay
that showed a viral load of 835,000 copies/mL. The patient probably
acquired the infection when he was using intravenous heroin, a practice he quit 10 years
ago. The patient is immune to both hepatitis A and hepatitis B viruses, and there is no coinfection
with HIV. Liver biopsy shows moderate cellular inflammation (grade 3) and bridging fibrosis
(stage 3) but no evidence of cirrhosis. Iron staining shows no abnormal iron deposition in the
liver. The HCV genotype is 1A.

WHAT WOULD YOU DO NOW?
A. Observe patient; check liver function tests
(LFTs) regularly; repeat biopsy in 3 to 5 years.
B. Recommend therapy with interferon and
ribavirin.
C. Initiate standard therapy for HCV infection and
screen periodically for hepatocellular carcinoma.
D. Offer alternative therapy with silymarin and
vitamin E.

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