Disease course
 

David Bernstein MD: The disease course of hepatitis C is highly variable and unpredictable. The overall natural history belief is that 16 to 20% of patients after twenty years of disease will go on to develop cirrhosis. Having said that, the vast majority of patients with the disease won't go on to develop cirrhosis. Unfortunately, we're unable to predict the disease progression of hepatitis C in any individual patient.

Robert Brown MD: Hepatocellular carcinoma is a complication of hepatitis C almost solely in the setting of cirrhosis. Once cirrhosis has developed, however, hepatocellular carcinoma or HCC can occur at a rate of 1 to 5% per year.

David Bernstein MD: Screening for hepatocellular carcinoma in the United States is controversial. The modalities used are serum alpha-fetoproteins and or an abdominal ultrasound. The frequency is uncertain, and many people will screen cirrhotic patients only every three months, every six months or once a year.

Robert Brown MD: The standard screening regimen is alpha-fetoprotein in the serum every six months and ultrasound every 6 to 12 months. Most people have been using ultrasound and alpha-fetoprotein every six months.

Rajender Reddy MD: Of course, there is the question of cost-effectiveness of this strategy. Regardless, it would appear that most would agree that surveillance for hepatocellular carcinoma is important in these patients. The reason for such surveillance is that there are effective therapies for patients who have a relatively early stage hepatocellular carcinoma, and therapies include liver transplantation.

Robert Brown MD: Hepatitis C is the most common indication for liver transplantation in the United States. About 40% of the patients transplanted in the US, or somewhere around 2,000 cases per year, are for hepatitis C and its complications. However, it is the minority of patients with hepatitis C who will need a liver transplant. Only about anywhere between 5% and 10%.