Presentation of hepatitis C in a unique uniform cohort 17 years from inoculation

Crowe, J.; Doyle, Christine; Fielding, J. F.; Holloway, H.; Keegan, Mark; Kelleher, Dermot; Kelly, Peter C.; Leader, M.; Little, Melvyn; McDonald, G. S. A.; McCarthy, C. F.; McWeeney, J.; O’Keane, Conor; Rajan, Elizabeth; Walsh, Laura; Weir, Donald G.; Whelton, M. J.

doi:10.1016/0016-5085(95)28518-0

Cited by 30 publications

(27 citation statements)

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“…[13][14][15][16]19,21,22 Several au- thors have found a low incidence of life-threatening events and liver-related deaths during the second decade of HCV infection. 8,11,12,17,29 In the present study, the likely time of HCV acquisition was known for only 38% of those who developed liver-related complications. As a result, the failure to find a difference in duration of HCV infection between cases with or without liver-related complications is likely to be misleading, particularly because the duration of HCV infection may be substantially longer for sporadic cases.…”

Section: Discussionmentioning

confidence: 64%

Which patients with hepatitis C develop liver complications?

Khan

Farrell

Byth³

et al. 2000

Hepatology

149

124

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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...

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Section: Discussionmentioning

confidence: 64%

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

“…Our study cohort is representative and reflects the relative mild course of this particular form of hepatitis C 1b in Ireland (i.e., HCV 1b-contaminated Anti-D, from a single source), and clinical details from a larger patient population infected with HCV from the same source in Ireland support this. 31 The influences of competing etiologies such as alcoholicor acetaminophen-induced liver disease are not present in this cohort. Other modifiers, which may impact on disease activity, are HLA genotype and quasispecies diversity.…”

Section: Discussionmentioning

confidence: 83%

Viral load and clinicopathological features of chronic hepatitis C (1b) in a homogeneous patient population

et al. 1999

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“…9 years later presented as a volunteer blood donor and was found to be anti-HCV positive. His ALT levels were still In composite, the data from our donor and transfusion recipient studies and that of long-term cohort studies 7,8,10 elevated (100 U/L), and a repeat liver biopsy showed cirrhosis. One year later he developed mild hepatic decompensation suggest that less than 10% of HCV-infected patients will sustain liver-related mortality during the first two decades and an increasing alphafetoprotein level.…”

Section: The Clinical and Histological Findings Among Hcv-infectedmentioning

confidence: 83%

“…were infected by a contaminated lot of Rh immune globulin, only 2.4% had developed histological evidence of cirrhosis PROJECTIONS OF OUTCOME after a mean interval of 17 years. 8 …”

Section: Duration Of Hcv Infection and Clinical Outcomementioning

confidence: 99%

Hepatitis C in asymptomatic blood donors

et al. 1997

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Among 248 asymptomatic blood donors positive for anti-widespread in the blood donor population, that hepatitis C accounted for more than 90% of transfusion-transmitted body to hepatitis C virus (anti-HCV) enrolled in a long-term prospective study, 86% had chronic HCV infection and 14% hepatitis, and that chronic HCV infection, although generally asymptomatic, could in some cases lead to cirrhosis, hepatoappeared to have recovered as assessed by serial determinations of serum alanine aminotransferase (ALT) levels and cellular carcinoma (HCC), and end-stage liver disease. 2,3First-generation tests for anti-HCV were introduced into HCV RNA by polymerase chain reaction. Established parenteral risk factors for HCV transmission were identified in blood donor screening in 1990. At that time, 0.5% to 0.6% of donors were repeatedly reactive by enzyme immunoassay 75% of donors. In addition, there was a strong independent association between HCV positivity and cocaine snorting, sug-(EIA), and approximately 0.3% could be confirmed as positive by supplemental strip recombinant immunoblot assay. gesting that shared snorting devices may be a covert route of parenteral transmission. Ear piercing in males was also More sensitive second-and third-generation EIAs 4 were introduced in 1992 and 1996, respectively. Current data from significantly associated with transmission. There was no evidence for sexual spread. Although the majority of HCV carri-the American Red Cross indicate that 0.23% of blood donors now test repeatedly positive for anti-HCV, and 0.16% can be ers had both biochemical and histological evidence of chronic viral hepatitis, the extent of liver injury was generally mild. confirmed by supplemental assays. These tests have been extremely effective in the prevention of transfusion-associAmong a larger population of 280 HCV RNA-positive donors, 17% had repeatedly normal ALT levels, 45% had levels that ated hepatitis. An ongoing prospective study of transfusion recipients at the Clinical Center of the National Institutes did not exceed twice, and only 22% had levels that exceeded five times the upper limit of the normal range. Among 81 of Health (NIH) has shown no cases of hepatitis C among approximately 650 recipients monitored since second-generpatients who underwent liver biopsy, only 13% had evidence of severe hepatitis (8%) or cirrhosis (5%), despite a duration ation EIA screening was implemented.Screening assays for anti-HCV have uncovered a large of infection that generally exceeded 15 years. No severe histological lesions were observed in blood donors with chronic group of patients who are asymptomatic HCV carriers. Population-based surveys suggest that there are almost four mil-HCV infection who had repeatedly normal ALT levels. In both donors and blood recipients, the frequency of severe lion HCV carriers in the United States. Furthermore, this virus is globally distributed, with anti-HCV rates among domorbidity or mortality related to HCV infection was less than 10% during the first two decades of infection....

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Presentation of hepatitis C in a unique uniform cohort 17 years from inoculation

Cited by 30 publications

References 0 publications

Which patients with hepatitis C develop liver complications?

Which patients with hepatitis C develop liver complications?

Viral load and clinicopathological features of chronic hepatitis C (1b) in a homogeneous patient population

Hepatitis C in asymptomatic blood donors

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