Treatment For Hepatitis C
The Canadian Liver Foundation believes that the decision to undertake treatment for hepatitis C should be made by a physician and patient and that neither normal transaminases nor mild liver injury shown by liver biopsy are contra-indications to treatment.
Hepatitis C infection causes a chronic liver disease that over time results in the development of cirrhosis, liver failure and hepatocellular carcinoma (liver cancer). Although the rate at which the disease progresses is generally slow, the rate is unpredictable in any one individual.
Currently, liver biopsy and transaminases tests (ALTs) are used to determine the progress of the disease. However, if the biopsy shows mild liver injury or if the transaminases are normal, this does not necessarily mean that the patient’s prognosis is good. Liver biopsy is often unreliable, under representing the severity of disease in up to 30% of cases. Although liver biopsy can be helpful in determining the extent of liver damage, it is not sufficiently dependable to make it the sole deciding factor in treatment decisions.
The alanine aminotransferase concentration is a marker of inflammation in the liver, but only reflects inflammation over the last few days prior to the measurement. It does not provide any information about long term liver injury. It is therefore not appropriate to make a treatment decision on the basis of ALT alone.
Provincial reimbursement agencies that refuse reimbursement based on liver biopsy results or ALT levels alone are ignoring evidence from medical science, and are acting in a way contrary to accepted medical practice. Such refusal to provide reimbursement is also not economically sound as most of these patients will require treatment at some stage, and with the new agents coming in the near future treatment will be much more expensive.
To download a PDF of this position statement, click here.