Affiliation: Division of Gastroenterological Surgery, Department of Surgery, Shinshu UniversitySchool of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
Hepatitis C is an important cause of chronic liver disease, with an estimated 150 million persons worldwide. In the United States alone, about 2.7 to 4 million persons are infected with hepatitis C virus (HCV). Studies of the natural history have been somewhat contradictory but indicate that over the first 20 years of chronic HCV infection, 20% of chronically infected patients will develop cirrhosis, and many of those will progress to hepatocellular carcinoma. HCVassociated end-stage liver disease is now recognized as a leading indication for liver transplantation in the United States and the developed western world. The vast number of patients with hepatitis C represents a huge medical and economic burden. Thus, it is crucial to identify patients suitable for treatment and those who may benefit most from therapy. Antiviral therapy is recommended for those patients with chronic hepatitis C. Currently there are two major antiviral agents; interferon and ribavirin for the treatment of HCV-infected patients. Many studies have shown a significant benefit to combination therapy of interferon and ribavirin for patients with HCV. At present, combination of pegylated interferon and ribavirin seems to be the most effective antiviral therapy for patients with chronic hepatitis C. However, only about 50% to 60% of the patients responded to pegylated interferon and ribavirin combination therapy. Therefore, it has become important to develop more effective antiviral agents against the various viral targets. New potent antiviral agents like HCV NS3 protease inhibitors and / or NS5B RNA-dependent RNA polymerase inhibitors may provide hope and excitement for treatment of HCVinfected patients. In this article, we would like to focus on current issues of antiviral therapy for hepatitis C including the issue of liver transplantation and hepatic resection for such patients.