Hispathology of chronic hepatitis C in relation to epidemiological factors

Delladetsima, J.; Rassidakis, George Z.; Tassoppoulos, Nicolaos C.; Papatheodoridis, George V.; Smyrnoff, Tatiana; Vafiadis, I.

doi:10.1016/s0168-8278(96)80182-6

Cited by 59 publications

(34 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Age clearly influences histological progression of chronic hepatitis C, as we have described previously in this cohort, 6 and as documented in other studies. 1,2,5,20,33,34 Age may partly explain the observed differences in outcome between published cohorts of patients with chronic hepatitis C. 13,15,16,22,28 In the present study, complications were rare in those aged less than 41 years, who comprised 61% of the study population. Age could also explain the lower rate of complications, only 2%, that was evident among the 198 patients who acquired HCV from IDU, a finding consistent with the observations of Gordon et al 22 In this and other studies, 13,28 gender had no effect on liver-related complications other than the development of HCC, which as observed in many diseases is more common in men.…”

Section: Discussionmentioning

confidence: 60%

“…The factors that influence the rate of fibrotic progression in hepatitis C virus (HCV) include age at the time of HCV infection and at initial evaluation, male sex, HCV genotype, and alcohol consumption. [1][2][3][4][5][6][7][8] It is less clear as to whether any of these factors influence the onset of liver-related complications other than by their effects on the rate of fibrotic progression.The proportion of all patients with hepatitis C who develop life-threatening complications is also unclear. Many studies are confined to either the first 20 years of HCV infection when complications appear to be unusual, [8][9][10][11][12][13][14][15] or to the late stage of the disease when cirrhosis is present.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Which patients with hepatitis C develop liver complications?

Khan

Farrell

Byth³

et al. 2000

Hepatology

149

124

View full text Add to dashboard Cite

To identify variables that are independent predictors of adverse outcomes in chronic hepatitis C, we analyzed a cohort of 455 patients followed for a median of 4.7 years. Associations were sought between demographic and behavioral factors, hepatitis C virus (HCV) genotype, liver histology and liver tests at entry, and development of liver complications, hepatocellular carcinoma (HCC), hepatic transplantation and liver-related death. Independent predictors were identified by multivariate analysis. The following were associated with a significantly higher rate of liver complications: age; birth in Asia, Europe, Mediterranean region, or Egypt; transmission by blood transfusion or sporadic cases; HCV genotypes 1b and 4 (compared with 1/1a); fibrosis stage 3 or 4 (cirrhosis); serum albumin; bilirubin; prothrombin time; and ␣-fetoprotein. However, the only independent predictors of liver-related complications were sporadic transmission (P F .001), advanced fibrosis (P ‫؍‬ .004), and low albumin (P F .001). The corresponding independent risk factors for HCC were male gender (P ‫؍‬ .07), sporadic transmission (P F .001), and albumin (P F .001); bilirubin (P ‫؍‬ .02) was an additional predictor of transplantation or liver-related death. It is concluded that only patients with advanced hepatic fibrosis or cirrhosis, are at risk of developing hepatic complications of chronic hepatitis C during 5-year follow-up. Among such patients, abnormalities in serum albumin, bilirubin, or prothrombin time indicate a high probability of complications. The rate of fibrotic progression in chronic hepatitis C is highly variable, 1 and the natural history of the disease usually extends over several decades. In some patients, it may culminate in the life-threatening liver complications of portal hypertension, hepatocellular carcinoma (HCC), and liver failure requiring hepatic transplantation or leading to liverrelated death. Such complications are rarely noted in the absence of cirrhosis. The factors that influence the rate of fibrotic progression in hepatitis C virus (HCV) include age at the time of HCV infection and at initial evaluation, male sex, HCV genotype, and alcohol consumption. [1][2][3][4][5][6][7][8] It is less clear as to whether any of these factors influence the onset of liver-related complications other than by their effects on the rate of fibrotic progression.The proportion of all patients with hepatitis C who develop life-threatening complications is also unclear. Many studies are confined to either the first 20 years of HCV infection when complications appear to be unusual, [8][9][10][11][12][13][14][15] or to the late stage of the disease when cirrhosis is present. [13][14][15][16] Thus some cohort studies have found low mortality rates at 17 to 20 years, particularly among younger individuals and among those who have a risk factor other than blood transfusion. 8,9,11,12,17 Others have indicated that approximately 18% of patients develop liver-related complications or HCC or succumb to liver-related death within 18 year...

show abstract

Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 99%

Which patients with hepatitis C develop liver complications?

Khan

Farrell

Byth³

et al. 2000

Hepatology

149

124

View full text Add to dashboard Cite

show abstract

“…Hepatic steatosis is one of the histopathologic features of chronic hepatitis C. [15][16][17][18] According to previous reports, the prevalence of hepatic steatosis ranges from 31 to 72%. [15][16][17][18][19][20] The pathogenesis of hepatic steatosis in patients with chronic HCV infection has been postulated recently.…”

mentioning

confidence: 99%

“…[15][16][17][18][19][20] The pathogenesis of hepatic steatosis in patients with chronic HCV infection has been postulated recently. Both in vitro studies and in vivo studies have shown that HCV core protein expression either in cell cultures or in transgenic mice led to the development of hepatic steatosis, contributing to carcinogenesis.…”

mentioning

confidence: 99%

Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection

Ohata¹,

Hamasaki²,

Toriyama³

et al. 2003

Cancer

292

224

View full text Add to dashboard Cite

BACKGROUNDHepatic steatosis is one of the histopathologic features of chronic hepatitis C. It was reported recently that the expression of hepatitis C virus (HCV) core protein in transgenic mice induced hepatocellular carcinoma (HCC) in association with steatosis. The objective of this study was to determine the relation between hepatic steatosis and hepatocarcinogenesis in patients with chronic HCV infection.METHODSThe authors studied 161 patients with chronic HCV infection who were diagnosed at Nagasaki University Hospital, Nagasaki, Japan, between January 1980 and December 1999. Age, gender, body mass index (BMI), habitual drinking, diabetes mellitus, serum alanine aminotransferase (ALT) level, HCV serotype, serum level of HCV core protein, interferon (IFN) treatment, hepatic fibrosis inflammation, and hepatic steatosis were studied with regard to their significance in the development of HCC using univariate and multivariate analyses.RESULTSThe cumulative incidence rates of HCC were 24%, 51%, and 63% at 5 years, 10 years, and 15 years, respectively. Multivariate analysis identified hepatic steatosis, together with aging, cirrhosis, and no IFN treatment, as independent and significant risk factors for HCC (P = 0.0135, P = 0.0390, P = 0.0068, and P = 0.0142, respectively). In addition, hepatic steatosis was correlated with BMI, serum ALT levels, and triglyceride levels.CONCLUSIONSThe findings of the current study indicate that hepatic steatosis is a risk factor for HCC in patients with chronic HCV infection. Patients with chronic HCV and hepatic steatosis should be monitored carefully for HCC. Cancer 2003;97:3036–43. © 2003 American Cancer Society.DOI 10.1002/cncr.11427

show abstract

“…Above factors have already been validated in literature 4,5,11,18 . We also found that age, weight, sex, AST/ALT ratio and genotype has no impact on fibrosis, where increasing age (> 35 years) and AST / ALT ratio > 1 has correlation with severity of fibrosis (21). Similarly, genotype also has no impact in reported study 4 .…”

Section: Discussionmentioning

confidence: 48%

Liver Biopsy in Patients Infected With Chronic Hepatitis C and Persistently Normal Serum Alt Levels

2008

j liaquat uni med health sci

View full text Add to dashboard Cite

RESULTS: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7± 9.78 years; out of these 39 (70.9%) were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 (43.6%) patients with stage (fibrosis) equal or greater than 2 and 33 (60%) had biopsy grade equal or greater than 2. Eighteen (32.7%) patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis (p< 0.01). CONCLUSION: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients. INTRODUCTIONApproximately 30-40% of the patients with chronic hepatitis "C" have persistently normal alanine aminotransferase (ALT) levels 1 . Antiviral treatment for patients with CHC infection has generally been limited to those with significantly abnormal serum ALT activity (2). Previously patients with normal ALT which consists mostly of female population and have lesser degree of inflammation and fibrosis used to be excluded from clinical trials (3, 4, 5, and 6). In past normal ALT levels even have been used as a surrogate marker for treatment response (7). It is true that if ALT levels are persistently normal, the possibility of significant and progressive liver disease tends to be low, but a significant proportion of patients with persistently normal ALT levels show some histological signs of fibrosis, the degree of which is usually mild but sometimes more marked and in rare cases, cirrhosis may be present (2). In fact in some series up to 14 to 20% of patients with normal ALT have advanced cirrhosis and advanced fibrosis on liver biopsy. It is a recognized fact that all of them do not have mild liver disease and slower disease progression 1,3,8 . Around 90% of HCV carriers with persistently normal ALT (PNALT) have normal to mild inflammation and fibrosis on liver histology. Long term follow-up studies suggest that 30% of such carriers became candidates for antiviral therapy within 5 years 9 . Persistently normal ALT in most studies is defined as "at least three normal ALT levels over a six month period". The degree of liver injury in patients with PNALT may not differ from the matched controls with elevated ALT 10. The efficacy and safety of pegylated interferon alfa-2a and ribavirin combination therapy in patients with chronic hepatitis C and PNALT are similar to that in patients with elevated ALT. The indication for treatment of hepatitis C can be evaluated independently from baseline ALT activity 11 . In many studies it is shown that normal ALT levels do not preclude the abnormal liver histology so we decided to perform this study to evaluate correlation between PNALT levels in patients with CHC and histological features of liver at our tertiary care center of Hyderabad, Pakistan. Liver ...

show abstract

Hispathology of chronic hepatitis C in relation to epidemiological factors

Cited by 59 publications

References 22 publications

Which patients with hepatitis C develop liver complications?

Which patients with hepatitis C develop liver complications?

Hepatic steatosis is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C virus infection

Liver Biopsy in Patients Infected With Chronic Hepatitis C and Persistently Normal Serum Alt Levels

Contact Info

Product

Resources

About