Therapy: Alternative Clinical Scenario
A 35 year old former intravenous drug user who is now a successful investment banker has been found to be HCV RNA positive. He last injected drugs 10 years ago after a 3 year period of needle sharing. He is sent to see you for advice on treatment for his viral hepatitis. A liver biopsy reveals periportal inflammation, some piecemeal necrosis and early fibrosis. He drinks 30 units of alcohol per week. He wants to know if he should have treatment and if so, does combination therapy of interferon with ribavirin really offer much more chance of viral clearance than interferon alone or just waiting to see what happens.
You formulate the question, "In 35 year old man who is HCV RNA positive does treatment with interferon + ribavirin, compared to interferon alone, or no treatment, offer a significant chance of viral clearance." Fortunately, you have brought your notebook computer with you which has the latest version of Best Evidence on it. You search Best Evidence using the term " hepatitis c" and "randomised controlled trial" find an abstract and commentary on an article by Poynard et al which looks promising. Lancet 1998;352:1426-32. You tell the patient that you will obtain this article from your office and will return to him with the evidence.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?