Persons recommended for therapy with interferon are those with chronic infection who are at greatest risk for progression to cirrhosis.
(1) persistently elevated ALT (SGPT) levels,
AND
(2) detectable HCV RNA,
AND
(3) a liver biopsy shows either portal or bridging fibrosis or at least moderate degrees of inflammation and necrosis.
Persons for whom treatment is not recommended
(1) patients with persistently normal ALT levels
(2) patients with advanced cirrhosis who might be at risk for decompensation with therapy
(3) patients who are currently drinking excessive amounts of alcohol or who are injecting illegal drugs; treatment should be delayed until these behaviors have been discontinued for >= 6 months
(4) women who are pregnant
(5) persons with:
(5a) major depressive illness
(5b) cytopenias
(5c) hyperthyroidism
(5d) renal transplantation, or
(5e) autoimmune disease
Persons for whom treatment is unclear:
(1) patients with compensated cirrhosis (without jaundice, ascites, variceal hemorrhage or encephalopathy)
(2) patients with persistent ALT elevations but with less severe histologic changes (no fibrosis, minimal necrosis and inflammation). In these patients progression to cirrhosis is likely to be slow if at all. Observation and serial measurement of ALT and liver biopsy every 3-5 years is an acceptable alternative to treatment with interferon.
(3) patients who are < 18 years of age (interferon not approved for this age group) or > 60 years
