patients at risk for cirrhosis should be considered for treatment of hcv. according to a consensus statement from the national institutes of health these include persons with: hcv infection and persistent elevation of alt (alanine aminotransferase a liver enzyme in the blood). high levels of hcv rna in the blood. hcv infection and evidence of fibrosis (scarring) on liver biopsy. hcv infection and evidence of at least moderate inflammation and liver cell injury (necrosis) on liver biopsy. these are general guidelines. patients and providers may decide that treatment is needed for other reasons. for example patients with hiv have a more rapid course of liver injury and may need treatment at an earlier stage. newer therapies may be offered to selected patients in research settings. individuals who should not be treated with antiviral therapy include those who are unable to comply with the treatment schedule who should not take the specific medications (for example because of an allergy) and who have reversible serious untreated conditions such as unstable heart disease uncontrolled high blood pressure or untreated major depression. patients with unstable (decompensated) cirrhosis are at high risk for complications from treatment and usually do not receive medical treatment except in research settings. fundamentally the decision regarding antiviral therapy in chronic hcv infection should be tailored to the individual patient with careful consideration of the risks and benefits. all patients with hcv should be vaccinated against hepatitis b and hepatitis a. they also should be counseled on measures to prevent the spread of hcv and eliminating alcohol use. finally risk behaviors for hcv overlap with those of hiv and all patients with hcv should be tested for hiv. treatment responses are mainly defined by results of the hcv rna testing. four patterns of response to antiviral treatment have been described: sustained virologic response. relapse. partial response. non-response. sustained virologic response the optimal response is a sustained virologic response defined as the absence of detectable hcv rna in serum using a sensitive test at the end of the treatment and six months later. most of these individuals will remain in remission (no signs of the disease) indefinitely with no detectable hepatitis c virus rna in the blood or liver. moreover follow-up biopsies show a marked reduction in inflammation and there even can be regression of scarring. longer follow-up of these patients is necessary however to evaluate definitively whether sustained responders will avoid the complications of cirrhosis and live longer. relapse relapsers are patients who initially eliminate the rna from their blood but then develop detectable rna again shortly after discontinuing therapy. the rna becomes detectable again within six months and usually within the first three months of stopping treatment. partial responders patients whose hcv rna levels decline but never become undetectable are referred to as partial responders. no response patients who have sustained levels of detectable hcv rna during therapy are known as non-responders. patients in whom hcv rna becomes undetectable during the early period of treatment but reappears before the end of therapy should probably likewise be considered non-responders. this reappearance of hcv rna during therapy is referred to as a "breakthrough" of hcv.
who should receive antiviral therapy for hepatitis c virus?