EASL International Consensus Conference on Hepatitis C Paris, 26–28 February 1999: Consensus Statement*

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1. What are the Public Health Implications of Hepatitis C?

Hepatitis C is a major health problem. The global prevalence of chronic hepatitis C is estimated to average 3% (ranging from 0.1 to 5% in different countries): there are some 150 million chronic HCV carriers throughout the world, of whom an estimated 4 million are in the USA and 5 million in Western Europe. The prevalence seems to be higher in Eastern Europe than in Western Europe. In industrialized countries, HCV accounts for 20% of cases of acute hepatitis, 70% of cases of chronic hepatitis,

2. What is the Natural History of Hepatitis C? What are the Factors Influencing the Disease?

Hepatitis C is a disease with various rates of progression. In general, its course is slowly progressive. About 15% of HCV-infected individuals recover spontaneously; an additional 25% have an asymptomatic illness with persistently normal aminotransferases and generally benign histological lesions; hence, about 40% of patients recover or have a benign outcome. In those with biochemical evidence of chronic hepatitis, the majority have only mild to moderate necro-inflammatory lesions and minimal

3. Diagnostic Tests

ELISA tests are easy to use and inexpensive, and are the best tests for initial screening. These tests are reliable in most immunocompetent patients who replicate HCV. They are less sensitive in hemodialyzed and in immunocompromised patients.

In low-risk settings, such as blood banks and other general screening situations where approximately 25% of ELISA positive results may be false, a supplemental specificity test, such as a strip immunoblot assay, is recommended to avoid unwarranted

4. Who Should be Screened for Hepatitis C?

General screening is not advisable. Screening should be limited to risk groups: (a) persons who have (or might have) received blood products prior to initiation (1991) of second-generation ELISA test; (b) hemophiliacs; (c) hemodialyzed patients; (d) children born to mothers who have hepatitis C; (e) current or previous users of intravenous drugs; (f) donors for organ or tissue transplantation.

5. How Can the Transmission of Hepatitis C be Prevented?

The two main sources of infection are intravenous drug use and administration of blood products. The latter source has almost completely disappeared since 1991.

Sexual transmission is very uncommon: the prevalence of HCV infection in stable partners of homosexual or heterosexual individuals infected with HCV is very low, but is higher in persons with multiple partners. The use of condoms in stable monogamous relationships is not justified; the use of condoms is strongly encouraged in patients

6. Which Patients Should be Treated?

The decision to treat is a complex issue which must take into consideration numerous variables: age of the patients, general state of health, risk of cirrhosis, likelihood of response, and other medical conditions that may decrease life expectancy or contraindicate the use of interferon or ribavirin.

7. What is the Optimal Treatment?

In naive patients, the combination of interferon and ribavirin should be offered to those without contraindications. The duration of therapy depends on the genotype and level of viremia. In patients with genotype 2 or 3, the duration is 6 months (regardless of the level of viremia). In patients with genotype 1, the current data suggest that 6 months is sufficient if the level of viremia is low (less than 2 million copies/ml); 12 months of treatment is recommended if the level of viremia is high

8. How Should Untreated and Treated Patients be Monitored?

Laboratory tests are not very reliable in monitoring the progression of liver disease in hepatitis C patients. Nevertheless, checking blood counts, including platelet counts and liver enzymes every 6 months is recommended. Liver biopsy is necessary to assess progression of fibrosis and cirrhosis. In patients in whom treatment has not been initiated because of mild liver disease at the initial biopsy, repeat liver biopsy at intervals of 4–5 years is recommended.

In patients with normal

9. Main Unresolved Issues: Treatment, Vaccination

Hepatitis C is an enormous present and future health burden to the world. Even by the year 2010, and allowing for falling prevalence, a huge backlog of infected patients will still be progressing towards cirrhosis and hepatocellular carcinoma. Even if it were possible at the present time to treat all those infected and so slow down the progression towards chronic severe liver disease, the cost of such large-scale investigations and therapy would be enormous.

Progress in our understanding of HCV

Members of the Organizing Committee

Patrick Marcellin (Chairperson) (Paris, France)

Alfredo Alberti (Padova, Italy)

Geoffrey Dusheiko (London, United Kingdom)

Rafael Esteban (Barcelona, Spain)

Michael Manns (Hannover, Germany)

Daniel Shouval (Jerusalem, Israel)

Ola Weiland (Huddinge, Sweden)

Roger Williams (London, United Kingdom)

Members of the Consensus Panel

Jean-Pierre Benhamou (Chairperson) (Paris, France)

Juan Rodes (Vice-Chairperson) (Barcelona, Spain)

Harvey Alter (Bethesda, USA)

Henri Bismuth (Paris, France)

Valeer Desmet (Leuven, Belgium)

Jaime Guardia (Barcelona, Spain)

Jenny Heathcote (Toronto, Canada)

Anna Lok (Ann Arbor, USA)

Willis C. Maddrey (Dallas, USA)

Karl-Heinz Meyer Zum Büschenfelde (Mainz, Germany)

Luigi Pagliaro (Palermo, Italy)

Gustav Paumgartner (Munich, Germany)

Sheila Sherlock (London, United Kingdom)

List of the Experts

Sergio Abrignani (Siena, Italy)

Alfredo Alberti (Padova, Italy)

Miriam Alter (Atlanta, USA)

Ferruccio Bonino (Pisa, Italy)

Flavia Bortolotti (Padova, Italy)

Christian Bréchot (Paris, France)

Miguel Carneiro de Moura (Lisbon, Portugal)

Vicente Carreño (Madrid, Spain)

Massimo Colombo (Milan, Italy)

Antonio Craxi (Palermo, Italy)

Gary Davis (Gainesville, USA)

Raffaele De Francesco (Roma, Italy)

Françoise Degos (Paris, France)

Adrian Di Bisceglie (Saint-Louis, USA)

Hans Dienes (Köln, Germany)

Geoffrey Dusheiko

References (0)

This statement was drawn up by the Consensus Panel.

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