Hepatitis C infection is a treatable disease.1 Generally, people with chronic hepatitis C are relatively asymptomatic but risk progression over time to cirrhosis and its complications. Combination antiviral therapy with pegylated interferon and ribavirin achieves sustained virological response rates of 42-80% depending on genotype.2 In August 2006 the National Institute for Health and Clinical Excellence (NICE) published updated guidelines for the management of patients with this infection.3 The guidance allows antiviral therapy for patients with hepatitis C viral RNA without the need for liver biopsy. This is a major change to the traditional practice of restricting treatment to patients with moderate or severe disease on liver biopsy.

Specialists in the field, who are keen to increase the uptake of treatment in eligible patients, will welcome the new guidance. However, they together with people infected with the virus and those who seek to deliver appropriate medical care will remain frustrated. Although …