Management of chronic hepatitis C: clinical audit of biopsy based management algorithm.
OBJECTIVE
To assess the attendance, outcome, compliance with treatment, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy based algorithm.


METHODS
Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year.


METHODS
The liver unit at a London teaching hospital.


METHODS
255 patients with chronic hepatitis C.


METHODS
Patient survival, attendance, and compliance with diagnostic and therapeutic regimens. Response to interferon alfa treatment, based on loss of viraemia three months after cessation of treatment.


RESULTS
A large proportion of patients (39%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for further treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rate to interferon (21%) in treated patients was similar to that previously reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amounting to cirrhosis. In patients with cirrhosis there was a high incidence of hepatocellular carcinoma (18%) over a follow up period of 20 months.


CONCLUSIONS
Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large proportion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required.
Foster
G R
GR
Liver Unit, Imperial College School of Medicine at St Mary's, London.
Goldin
R D
RD
Main
J
J
Murray-Lyon
I
I
Hargreaves
S
S
Thomas
H C
HC
D000328:Adult; D000465:Algorithms; D000553:Ambulatory Care; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000821:virology; D002908:Chronic Disease; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000821:virology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000821:virology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D012189:Retrospective Studies; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha