Journal of Hepatology
1999; 31: (Suppl. 1): l-2 Printed in Denmark . All rights reserved Mmksgaard . Copenhagen
Copyright 0 European Association for the Study of the Liver 1999
Journal of Hepatology ISSN 0169-5185 ISBN 87-16-16386-9
EASL International Consensus Conference on Hepatitis C Patrick Marcellin
Hepatitis C is a major public health problem worldwide. The hepatitis C virus (HCV) infects nearly 170 million people in the world. In Europe, the overall prevalence is 1% with a north-south gradient, ranging from 0.5% in northern countries to 2% in Mediterranean countries. Recent studies have shown high prevalences in Eastern Europe, ranging from 0.7% to 5%. Post-transfusion hepatitis C has almost disappeared in Western countries and intravenous drug abuse is the main route of transmission. HCV infection is characterized by its tendency to chronicity related to the capacity of the virus to escape the immune response of the host. Therefore, 85% of infected people develop chronic infection which is generally asymptomatic. HCV-related chronic hepatitis is insidious and its severity is extremely variable, ranging from asymptomatic chronic infection with normal liver enzyme to severe chronic hepatitis evolving to cirrhosis and then to hepatocellular carcinoma with a delay ranging from a few years to many decades. Thus, HCV is a major cause of cirrhosis and hepatocellular carcinoma and in the last few years end-stage HCV related cirrhosis has become the first cause of liver transplantation. HCV was discovered 10 years ago by the group of Michael Houghton and considerable progress has been made in the knowledge of the virus, in diagnosis tests and therapy. Two years ago, a consensus conference on hepatitis C was organized by Jay H. Hoofnagle on behalf of the National Institutes of Health (NIH) in Bethesda. This consensus conference provided recommendations that were very useful for the management of hepatitis C patients. Since the NIH conference, significant progress has been made in the field of hepatitis C. l
The epidemiology of the infection and the natural history are better known. Virological advances have occurred with the improvement and the standardization of diagnostic tests. Tools are now available to quantitate the viral load and to type the virus, which has potential important implications for clinical practice.
The efficacy of therapy has markedly improved with the use of combination therapy.
These recent advances encouraged EASL to organize this consensus conference in order to define the state of the knowledge and to update the previous recommendations of the NIH conference. An organizing committee of academic scientists drafted nine questions to be addressed at the conference, developed an agenda, and selected the speakers. International experts in the fields of virology, epidemiology, natural history, prevention and the treatment of hepatitis C provided 2 days of presentations and discussion before a consensus panel was asked to weigh the scientific evidence and prepare a consensus statement for wide distribution. The consensus statement addressed the following nine questions: 1. What are the public health implications of hepatitis C? 2. What is the natural history of hepatitis C, what are the factors influencing the disease? 3. What is the best way to diagnose hepatitis C? 4. Who should be screened for hepatitis C? 5. How can the transmission of hepatitis C be prevented? 6. Which patients should be treated? 7. What is the optimal treatment - for ndive patients? - for relapsers after interferon treatment? - for non responders to previous IFN treatment? 8. How should untreated or treated patients be monitored? 9. What are the main unresolved issues? This supplement to the Journal of Hepatology presents the final statement of the Consensus Panel and the texts of the presentations made at the conference. The articles are reviews addressing the nine questions and providing the scientific evidence to support statements and recommendations made by the panel. I am grateful to the many people who helped to preI
pare this important symposium, including members of the organizing committee, speakers, panel members, and the many persons in the audience who participated
actively in discussions and who helped to formulate clear recommendations, which I hope will be useful for the management of hepatitis C.