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 24 April 2018

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Please submit a new question (maximum 100 words) or any comments to Please make sure you include the title of the Q&A you are commenting on in the subject line of your email. Please note that this service is only for medically qualified professionals, and not for the general public. The questions should be based on a clinical problem. You may nominate the expert from our Global Academic Faculty whom you would like us to contact for the first reply. Don't forget to include your full name, city, country and your email address.

The patient is a 46-year-old man with compensated cirrhosis (Child's class A), which was diagnosed after needle biopsy during surgery for intestinal obstruction. He has normal PT, Alb, ALT, AST and platelet count. No esophageal varices were found. The liver histology report was grade = 4 stage = 6; HCV-RNA was positive. No quantification or genotype testing is available.

How should he be treated?

Peyamn Adibi, Tehran, Iran  

Answer 1: It is not clear what grading system is being used here (e.g. Ishak or Knodell) and which score refers to inflammation and which to fibrosis. However, it sounds as if there is significant fibrosis and therefore a good case for combined treatment with interferon and ribavirin.


IT Gilmore, London, England  


Answer 2: In a patient with compensated HCV cirrhosis, treatment with pegylated interferon and ribavirin is appropriate with duration dependent on genotype.


R Zetterman, Omaha, Nebraska, USA  

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