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July 24, 1996

Hepatitis C: Watch for the Many or Treat for the Few?-Reply

Author Affiliations

University of Nebraska Omaha

JAMA. 1996;276(4):280-281. doi:10.1001/jama.1996.03540040024017

In Reply.  —Dr Rogers questions the desirability of treating patients with chronic hepatitis C in the absence of a predictably effective therapy for its eradication and lack of evidence that treatment will make any difference in the natural history of the disease. Although therapeutic skepticism is healthy, even commendable, the evidence that I presented would support the treatment of selected patients over an extended period with a reasonable expectation of viral eradication from the liver and resolution of the necroinflammatory process. What was emphasized in my discussion was that not all patients should be treated and if transaminase levels do not normalize within 8 to 12 weeks of starting interferon treatment, further treatment is futile. It does seem intuitively logical that if one can prevent cirrhosis, then patients will not die of cirrhosis. We now know that patients do not develop cirrhosis until they have had hepatitis C for 20 to 30