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July 24, 1996

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

JAMA. 1996;276(4):280. doi:10.1001/jama.1996.03540040024016

To the Editor.  —In the Clinical Crossroads article on asymptomatic hepatitis C infection,1 there seems to be a disjunction between the initial statistics on this epidemic disorder and the main thrust of the management advice. Dr Sorrell states that 3.5 million Americans have chronic hepatitis C while 8000 to 10 000 die of it annually. Even adding in the 1000 annual liver transplants attributed to hepatitis C, the ultimate bad outcome rate is 11000 a year. Even if we assume that the new ability to test blood donations will prevent further accretion to this vast reservoir of cases, in 30 years only 9% of the 3.5 million will develop end-stage disease or hepatoma. This is corroborated by the article by Seeff et al,2 which Dr Sorrell cites and then seems to ignore, that shows no effect of non-A, non-B hepatitis on 18-year total mortality and only the slightest