Estimating progression to cirrhosis in chronic hepatitis C virus infection

Abstract

To gain a clearer understanding of the rate of progression to cirrhosis and its determinants in chronic hepatitis C virus (HCV) infection, a systematic review of published epidemiologic studies that incorporated assessment for cirrhosis has been undertaken. Inclusion criteria were more than 20 cases of chronic HCV infection, and information on either age of subjects or duration of infection. Of 145 studies examined, 57 fulfilled the inclusion criteria. Least-squares linear regression was employed to estimate rates of progression to cirrhosis, and to examine for factors associated with more rapid disease progression in 4 broad study categories: 1) liver clinic series (number of studies ‫؍‬ 33); 2) posttransfusion cohorts (n ‫؍‬ 5); 3) blood donor series (n ‫؍‬ 10); and 4) community-based cohorts (n ‫؍‬ 9). Estimates of progression to cirrhosis after 20 years of chronic HCV infection were 22% (95% CI, 18%-26%) for liver clinic series, 24% (11%-37%) for posttransfusion cohorts, 4% (1%-7%) for blood donor series, and 7% (4%-10%) for community-based cohorts. Factors that were associated with more rapid disease progression included older age at HCV infection, male gender, and heavy alcohol intake. Even after accounting for these factors, progression estimates were much higher for cross-sectional liver clinic series. Selection biases probably explain the higher estimates of disease progression in this group of studies. Community-based cohort studies are likely to provide a more representative basis for estimating disease progression at a population level. These suggest that for persons who acquire HCV infection in young adulthood, less than 10% are estimated to develop cirrhosis within 20 years. (HEPATOLOGY 2001;34:809-816.)The majority of persons with hepatitis C virus (HCV) infection progress to chronic infection, which can lead to liver fibrosis and the subsequent occurrence of cirrhosis, liver failure, and hepatocellular carcinoma. 1 However, it is unclear what proportion of persons will develop HCV-related hepatic complications and who is most at risk of progression. The likelihood of progression can influence choice about therapy for the individual, and is a fundamental factor in predicting disease burden at a population level.Because chronic HCV infection is largely asymptomatic and runs a protracted and highly variable course, it has been difficult to reliably measure disease progression in epidemiologic studies. 2 Early studies in blood-transfusion recipients and liver clinic patients seemed to indicate that cirrhosis would develop in 20% to 50% within 20 years of acquiring HCV infection. 3,4 Then, several more recent studies suggested progression rates that were much lower, of the order of 2% to 10%. 5-9 Some interpreted these discrepancies as being caused by different distributions of factors associated with more rapid disease progression, such as age at HCV infection, gender, and source of HCV infection, between the study populations. The higher estimates, however, continue to be used to project disease bur...

Epidemiology and risk factors for hepatitis C in Alaska Natives

“…In a large U.S. multicenter study, higher levels of HCV RNA also has been found in males compared with females and in persons infected with genotype 1 versus genotypes 2 and 3. 24 Male gender has been shown to be a risk factor for the development of fibrosis 8,28 ; the higher level of HCV RNA found in men could be a factor in this process, yet this remains to be proven.…”

Molecular mechanisms of insulin resistance in chronic hepatitis C

“…Infection with the hepatitis C virus (HCV) is a leading cause of chronic liver disease, with over 3% of the world's population (180 million people) infected and 130 million at risk of cirrhosis [1] . The majority of infected individuals (60%-80%) develop chronic hepatitis C (CHC), which is associated with progressive liver fibrosis and a 3%-9% risk of cirrhosis after 20 years as shown in community-based studies [2] .…”

“…The majority of infected individuals (60%-80%) develop chronic hepatitis C (CHC), which is associated with progressive liver fibrosis and a 3%-9% risk of cirrhosis after 20 years as shown in community-based studies [2] . CHC is also associated with significant morbidity and mortality, accounting for 50%-76% of all liver cancer cases worldwide, and two thirds of liver transplants in the developed world [1] .…”

A record-linkage study of the development of hepatocellular carcinoma in persons with hepatitis C infection in Scotland

“…Development of HCC in HCV-infected persons usually requires 15 -25 years (Schafer and Sorrell, 1999;Freeman et al, 2001); the median lag between HCV diagnosis and hospitalisation/death with first mention of HCC in our study was much shorter, 2.3 years. Our study population, in particular those aged 40 and over at diagnosis, were likely tested and diagnosed as HCV antibody positive many years after infection, and in numerous cases, diagnosis was concurrent to or shortly followed first hospital admission with HCC.…”

“…An estimated 5 -15% of chronic HCVinfected individuals develop cirrhosis within 20 years after diagnosis (Freeman et al, 2001;Seeff, 2002;Benvegnù et al, 2004). In HCV-infected patients with established cirrhosis, the annual incidence and 5-year probability of HCC developing have been estimated at 3.5% (Hutchinson et al, 2005) and 28 -30% (Benvegnu et al, 2004;Sola et al, 2006), respectively.…”