Preparing the patient for success: Treat or wait?

Hepatitis C is a frequent cause of liver cirrhosis and, hepatocellular carcinoma worldwide. However, predicting clinical outcomes in patients with chronic hepatitis C is challenging. The risk of disease progression is not linear and can be associated with several factors. With the currently available therapies, around 70% of naïve patients, independently of hepatitis C virus genotype can achieve a sustained virologic response. Consequently, all hepatitis C virus patients are candidates for antiviral therapy. The decision to treat a patient with chronic hepatitis C virus infection is based on several factors, including the natural history of the disease, the stage of fibrosis, and the efficacy and adverse effects related to therapy. The decision to treat immediately or wait for a new drug is more difficult and should be tailored to each patient, taking into account the patient's characteristics, the risk of disease progression, the patient's wishes, and the experience of the attending physician.