Consensus of the Brazilian Society of Infectious Diseases on the management and treatment of hepatitis C

Each year, and every day, the results of clinical trials and basic research provide us with a great deal of new information regarding viral hepatitis. We on the Viral Hepatitis Committee of the Sociedade Brasileira de Infectologia (SBI, Brazilian Society of Infectious Diseases) have been working to standardize the major issues surrounding day-to-day practice in treating patients infected with the hepatitis B or C virus (HBV or HCV). We have decided to address, in alternate years, HBV, together with hepatitis delta (HDV), and HCV, in our annual 'Consensus' on clinical management. Last year, we published the first HBV Consensus (BJID, 2007 (11):2-6). This year, we submit our HCV Consensus, which primarily serves to update the 2002 and 2004 SPI Consensuses. We distributed the principal topics among the Committee members, revised their work and compiled it into a Proceedings Supplement (to be published together with the BJID), which elucidates the highlights of the Consensus. A deeper review was written and referenced (it is our advice to the reader to read the Proceedings as well). A meeting was then held in Mogi das Cruzes in order to discuss, in a very practical and directed way, the issues most relevant to the Consensus, from public policies to the most complex therapeutic points. The results are summarized in a question/ answer, topic/statement format in this issue of the BJID. The main message of our statement was that we need to have the courage to act in favor of life. Many of us have adopted certain practices based on very new knowledge despite a lack of formal or official policies to support such practices. Some of us have been awaiting new compounds while patients are dying of chronic liver diseases. Unfortunately, the news from the battlefield is not so good. New compounds have been very disappointing (low potency, viral resistance, ineffective without interferon and various side effects, some serious). It is also difficult to incorporate new policies into everyday practice. However, strategies Such as optimizing the use of pegylated interferon/ribavirin and encouraging treatment compliance, as well as finding new ways to monitor and slow liver disease progression, are effective and should be put into practice. Most importantly, the low-dose maintenance of pegylated interferon seems to be very promising, and the use of interferon alpha has saved lives. That is why we choose to expound upon what we believe to be the current standard of care and the gold standard for dealing with this hard to treat virus, as well as with the chronic complications of HCV infection. Our position will be reevaluated over the next two years. Until then, we are confident that our guide will be of great value to the readers. Finally, we would like to thank Roche and Schering Plough for the educational grants provided to the SBI. However, we must stress that neither company attempted to influence any of the decisions made by our consensus group.