Clinique universitaire d’hépato-gastroentérologie, pôle Digi-Dune, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France, IAPC, Inserm U823, institut Albert-Bonniot, rond-point de la Chantourne, 38706 La Tronche cedex, France
Viral eradication being not achievable, the goal of antiviral treatment is to obtain a profound virosupression that is thought to be associated to histological improvement and reduction of liver complication. Making treatment decision in a given patient should take into account the severity of liver disease at time of diagnosis, the risk of spontaneous severe outcome in terms of cirrhosis and hepatocellular carcinoma, but also the probability of therapeutic response. Recent international guidelines have been recently issued and provide important general issues about the way patients should be treated. For example, EASL guidelines recommend to treat patients with elevated ALT and/or viral load above 2,000 IU/mL when liver biopsy shows significant histological lesions. However, these guidelines cannot cover all clinical situations encountered by clinicians. Thus, therapeutic indications should be qualified on a case by case basis according to the predictable natural history of each patient.