In December 1995, at the Medicine Grand Rounds, Dr Michael Sorrell discussed Mr E, an impoverished man with a long history of substance abuse found to have asymptomatic hepatitis C infection during screening while he was in prison. Laboratory evaluation showed normal liver function tests, and the patient continued to feel well when first seen 3 years later by a general internist, Dr A. Dr A found no hepatomegaly, and liver function tests remained normal. Serologic testing for both hepatitis C and hepatitis B antibodies was positive. The patient's wife, who had tested negative for hepatitis C, was concerned about sexual transmission of hepatitis, and she urged the patient and his physician to consider further diagnostic and possible therapeutic strategies for his infection.
Dr Sorrell discussed the natural history, infectiousness, and management of hepatitis C, pointing out the frequently insidious course of progression to life-threatening disease. Nevertheless, given the lack