A detailed history and physical examination on the initial patient-physician encounter, will provide the most important early information leading to the therapeutic plan, and ultimately aid in managing the potential side effects of treatment. Taking a detailed history from the patient with chronic viral hepatitis will provide the approximate time and source of infection in many cases, symptoms of liver disease, if present, and disease co-factors, such as alcoholism and drug addiction. Furthermore, significant co-morbidities, such as uncontrolled depression or heart disease, which would be contraindications to treatment, will also be identified by the initial patient history (see Table 1).
A careful physical examination at the time of the initial evaluation will identify with reasonable certainty the patient with advanced liver disease, and additional medical conditions that might be contraindications to treatment. Important skin diseases, such as psoriasis and lichen planus, which are immune-mediated diseases that may worsen with IFN therapy, should be documented. A baseline retinal examination, at the time of the initial physical examination, should be done; IFN-associated retinopathy has rarely been reported to occur during treatment (5,6).
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