Roles of antiviral therapy in chronic hepatitis C patients should be different according to the stages of liver disease progression

With an accumulated evidence of natural course of patients with hepatitis C virus (HCV) infection, HCV infected patients died from liver-related disease such as liver cirrhosis/liver failure, or hepatocellular carcinoma. Based on these findings, beneficial effect of antiviral therapy for HCV patients is linked to an inhibition of HCC development. Because the difference of disease progression speed and fibrotic stage of the liver may affect the risk of HCC development and efficacy of antiviral therapy depends on virus load, genotype and host factors (age, gender, and fibrotic stage), the benefit of antiviral therapy may differ according to the step of natural course of HCV infection. In spite of improvement of treatment efficacy, antiviral therapy for these patients is still unsatisfactory, but recent studies revealed that retardation of disease progression could be observed after antiviral therapy. Thus, treatment for HCV infected patients should be performed from the standpoint of natural course of HCV infection.