Controversies Over Treatment

Clinicians, even those who are expert at treating liver disease and hepatitis C, may disagree about the best course of treatment. In some patients, medical conditions may increase the risk of treatment somewhat but not entirely eliminate the possibility. These "relative" contraindications may change over time as new research becomes available and clinicians gain experience with interferon and ribavirin. Cirrhosis is an example. Until recently, clinicians avoided treating patients with cirrhosis because of concern that the side effects would be intolerable and the liver disease would worsen. Now, however, many clinicians believe that patients with early cirrhosis can tolerate treatment.

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Likewise, some patients previously treated with interferon alone may be considered for retreatment with the combination protocol, or doctors may want to try a different pegylated interferon product. However, there is no general agreement as to whether retreatment is effective or cost-effective.

For people with normal liver enzymes, there is disagreement over whether treatment is called for. Some doctors believe that patients with persistently normal liver enzymes have a relatively benign prognosis and that the side effects of the drugs are not worth any minimal benefit. Others, however, note that patients can develop scarring and even cirrhosis in the presence of normal liver enzymes and believe that everyone should be treated.