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Five years after the first conference of consensus, the National agency of accreditation and assessment in Health (ANAES) has just returned new recommendations. Following the therapeutic progress and to the demands of the associations of patients, a new state of the places imposed itself. It was necessary to answer five big questions. As many major themes for the 500 000 to 600 000 carriers of the virus of the C hepatitis (VHC). What sick one must to treat?The treatment applies to the patients adult carriers of a chronic infection by the VHC authenticated by the presence of the viral RNA in blood. Will be treated the carriers of a moderate or stern chronic hepatitis, the patients affected by cirrhosis, and those whose infection is recent. The minimal chronic shapes will be merely the object of a simple surveillance, except in case of hepatic extra demonstrations or "strong demands." What are the most suitable exams before the treatment?The jury was especially waited on the necessity of a biopsy before the beginning of the treatment, whereas one knows that this exam continues to frighten. The experts didn't put back in causes the necessity of the previous biopsy but defined some exceptions: when the decision to treat doesn't depend on the diagnosis (obvious cirrhosis, some types of virus answering the treatment, the women having a project of pregnancy, better.). The experts also note that "the biologic scorers of fibrosis could constitute an alternative to the biopsy if they were validated in progress" by the studies. In December 2006, two methods non invasives (Fibrotest and Fibroscan) have been validated by the High Authority of Health in the assessment of the fibrosis for hepatitis chronic C non treated without comorbidité. What is the optimal treatment?The experts defined the therapeutic diagrams clean to the different diagnoses: interfEron pegyle + ribavirine or interferon only pegyle or standard interféron or ribavirine in monotherapie. Concerning the graft of liver, the bithérapie is again under assessment whereas the only interféron is not indicated. Finally, the findings underline the profit of a hold notably in global charge of the patient concerning the alcohol, the overweight, tobacco and the vaccinal recommendations. How to supervise the patients treaties?The criterias of surveillance of efficiency of the treatment didn't know any deep distresses: consistent biologic, virologique and histological. But the quality of life of the patients appears with more of importance. "Besides the regular specialized consultation, an accompaniment of proximity, ideally assured by the physician general practitioner, is essential considering the particularities of the chronic infection by the VHC and its treatment." How to follow the unprocessed patients? It is about the patients for which the treatment has not been kept or those that refused it. The modes of surveillance depend then on the hepatitis stage at the time of the diagnosis. These new recommendations should permit a better hold in charge of the patients, who were at the heart of plan "hepatitises" announced in February 2002 by Bernard Kouchner. 2009-03-02
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