Natural history of initially mild chronic hepatitis C

Alberti, Alfredo; Benvegnù, Luisa; Boccato, Silvia; Ferrari, Annachiara; Sebastiani, Giada

doi:10.1016/j.dld.2004.06.011

Cited by 57 publications

(60 citation statements)

References 62 publications

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“…Poynard et al 10 found that only 2% of patients infected before the age of 20 years developed cirrhosis over a period of 20 years, compared with 6% of those infected between 31 and 40 years, 37% of those infected between 41 and 50 years and 63% of those who contracted HCV over the age of 50 years. In our own study 11 , evaluating liver fibrosis progression in initially mild chronic hepatitis C, increasing age was associated with an increasing rate of fibrosis progression over a mean follow-up period of around 8 years.…”

Section: Host-related Factorsmentioning

confidence: 99%

Review article: chronic hepatitis C – natural history and cofactors

Alberti

Vario

Ferrari

et al. 2005

Aliment Pharmacol Ther

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SUMMARYChronic hepatitis C is highly heterogeneous in clinical presentation and outcomes.This heterogeneity is largely related to host factors that have been clearly proven to affect the severity and rapidity of disease progression. The most relevant factors that have been shown to accelerate progression to cirrhosis include age at infection, alcohol abuse and the metabolic syndrome with insulin resistance, obesity and hepatic steatosis.

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Section: Host-related Factorsmentioning

confidence: 99%

Review article: chronic hepatitis C – natural history and cofactors

Alberti

Vario

Ferrari

et al. 2005

Aliment Pharmacol Ther

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“…On the other hand significant fibrosis (> F2) has been reported in 5 -30% of the cases, with large variation among studies, when inclusion criteria and length of base line follow up was different. The cumulative percentage of HCV patients with PNALT with significant (> F2) fibrosis in liver biopsy among 1154 such cases included in 23 published studies, was 22% 20 . The prevalence of cirrhosis in HCV patients with PNALT ranged from 1 -6% in various studies 20 and one study .…”

Section: Discussionmentioning

confidence: 99%

“…The cumulative percentage of HCV patients with PNALT with significant (> F2) fibrosis in liver biopsy among 1154 such cases included in 23 published studies, was 22% 20 . The prevalence of cirrhosis in HCV patients with PNALT ranged from 1 -6% in various studies 20 and one study . In our series we have reported 7.3% of cirrhosis in PNALT patients and 18% with stage 3 or 4 fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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

2008

j liaquat uni med health sci

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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 ...

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“…In addition, numerous clinical trials failed to perform continuous, long-term observation of disease progression, resulting in significant differences in the rate of disease progression between various clinical trials (22)(23)(24)(25). One report showed that progression of mild fibrosis occurred over a median interval of 52.5 months, while another reported that progression of fibrosis occurred in patients with mild chronic HCV within 5-10 years after infection and was associated with age, alcohol consumption and inflammatory activity (26,27). Although children with chronic HCV showed no significant histologic progression of disease at 5 years after infection, almost a third of the children showed increased severity of Figure 1.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Disease progression in Chinese patients with hepatitis C virus RNA-positive infection via blood transfusion

Pan

Zheng

Qin

et al. 2016

Experimental and Therapeutic Medicine

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Abstract.The majority of patients with hepatitis C virus (HCV) in China were infected via blood transfusion prior to the year 1996. In this systematic retrospective cohort study, disease progression in 804 consecutive patients with transfusion-acquired HCV is investigated. In addition, the occurrence of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma (HCC) is analyzed among these patients, along with the risk factors for disease progression. Patients with cirrhosis or HCC were classified as the serious development group (SD group) and the remaining patients with chronic hepatitis were classified as the hepatitis group (H group). Significant differences were found between the two groups in age at the time of infection, duration of infection and age at the time of observation. SD group patients were significantly older at the time of transfusion (33.73 vs. 23.56 years; P<0.001), with a significantly longer mean duration of HCV infection (21.88 vs. 21.15 years; P=0.029) compared with that in the H group. Male gender and age at the time of transfusion were significant risk factors for HCC (OR=2.48, P=0.031 and OR=1.07, P=0.002, respectively). Age was a significant risk factor for disease progression in older Chinese patients with transfusion-acquired HCV, and there were significant differences in the prevalence of compensated cirrhosis, decompensated cirrhosis and HCC between the age groups (P<0.001), suggesting that more patients with HCV may develop cirrhosis or HCC in their third and fourth decades of infection. Results of the present study will be helpful for predicting disease progression in Chinese patients with HCV infected via blood transfusion.

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Natural history of initially mild chronic hepatitis C

Cited by 57 publications

References 62 publications

Review article: chronic hepatitis C – natural history and cofactors

Review article: chronic hepatitis C – natural history and cofactors

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

Disease progression in Chinese patients with hepatitis C virus RNA-positive infection via blood transfusion

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