Risk factors and predictors of outcome in an Australian cohort with hepatitis C virus infection

Abstract

Objectives: To define demographic and epidemiological features of an Australian population with chronic hepatitis C virus (HCV) infection and determine predictors of histological and clinical outcome. Design: Cohort study. Patients and setting: 342 consecutive HCV antibody‐positive patients referred to the liver clinic of a major metropolitan general hospital. Outcome measures: Demographic data, serial alanine aminotransferase (ALT) levels, full blood count for all patients. Percutaneous liver biopsy in 152 patients (44%). Results: 51% of patients had previously used injecting drugs, 15% had received a blood transfusion and 27% had no definite percutaneous risk factor (sporadic group). The injecting drug users (IDUs) were younger and more likely to have been born in Australia. The sporadic group were older and frequently were born in Mediterranean or Asian countries. A history of excessive alcohol use was common, particularly among IDUs (60%). Of 152 patients who had a liver biopsy, 49 had cirrhosis and 103 had chronic hepatitis. Some patients with a normal ALT level had marked necro‐inflammatory activity. On univariate analysis, the presence of cirrhosis correlated with older age (P < 0.0001), lack of an identifiable risk factor (P < 0.001) and birth in a Mediterranean or Asian country (P < 0.0001). On multivariate analysis, the only significant predictor of cirrhosis was age (P < 0.001). Among patients with an identifiable percutaneous risk factor, cirrhosis was seen at a median time of 18 years after first exposure to risk, compared with 13 years in patients with chronic hepatitis (P < 0.01). Patients with clinical evidence of portal hypertension were, on average, 15 years older than those with histological cirrhosis only (P < 0.01). Conclusions: Injecting drug use is the major risk factor for chronic HCV infection in Australia. In patients with an identifiable risk factor, the most significant factor associated with a biopsy finding of cirrhosis is the time since first exposure to HCV.

Changes in hepatitis C‐related liver disease in a large clinic population

“…Cirrhosis was diagnosed in 18% of our group who underwent liver biopsy. This is significantly lower than the 32% found in the report by Strasser et al 14 The present larger population sample is likely to be more representative of the HCV community in Australia; however, there is still likely to be some referral bias in this clinic population. Other investigators have reported cirrhosis in 18–21% of their subjects 7,19 .…”

“…A history of IDU was present in 64% of patients, compared with 51% in the previous report 14 . Furthermore, over two‐thirds (68%) of HCV patients seen in our clinics over the last 4 years have been IDU.…”

“…Since our previous report, 14 there have been a number of changes in the HCV population. The percentage of patients referred from the blood bank has fallen significantly, while those referred by general practitioners have more than doubled.…”

“…We have previously reported our findings on 342 patients with HCV infection, 152 of whom had undergone a liver biopsy 14 . Since the time of that report, our HCV population has grown significantly.…”

Overview: Liver disease and transplantation

“…In addition to Farrell and the Westmead group Paul Desmond has made substantial contributions in this area as well as in viral hepatitis. His research has centered around (i) Drug metabolism in liver disease particularly the relative preservation of glucuronosyl‐transferase enzymes in comparison with Cytochrome P450 (this followed working with Dr. Stephen Schenker in Nashville, USA); 46 (ii) hepatitis C around clinical outcomes based on a large database of patients seen over 18 years at St Vincents and collaboration with Stephen Locarnini in basic research 47 and clinical trials; 48 (iii) hepatitis B clinical and basic research particularly in collaboration with Locarnini; and (iv) clinical research into biliary disease particularly the definitive study on accuracy of MRCP.…”