The pathology of hepatitis C as a function of mode of transmission: Blood transfusion vs. Intravenous drug use

Gordon, C; Elloway, Richard S.; Long, John C.; Dmuchowski, Carl

doi:10.1002/hep.1840180609

Cited by 117 publications

(45 citation statements)

References 27 publications

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“…These studies reinforce the influence of age on the natural history of hepatitis C. On the other hand, studies conducted on older patients contaminated through blood transfusion have reported cirrhosis in about 50% of cases [3,16,17].…”

Section: Discussionsupporting

confidence: 67%

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Costa¹,

Ferraz²,

Perez³

et al. 2002

Braz J Infect Dis

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There is increasing interest in the identification of factors associated with liver disease progression in patients infected with hepatitis C virus (HCV). We assessed host-related factors associated with a histologically advanced stage of this disease and determined the rate of liver fibrosis progression in HCV-infected patients. We included patients submitted to liver biopsy, who were anti-HCV and HCV RNA positive, who showed a parenteral risk factor (blood transfusion or intravenous drug use), and who gave information about alcohol consumption.Patients were divided into two groups for analysis: group 1 -grades 0 to 2; group 2 -grades 3 to 4. The groups were compared in terms of sex, age at the time of infection, estimated duration of infection and alcoholism Hepatitis C virus (HCV) infection affects people worldwide and about 170 million individuals are estimated to be chronically infected with HCV. Several aspects of the natural history of this disease are still not completely understood.After acute infection, viremia persists in 85% of the patients [1] and most of them develop chronic hepatitis. Different studies have shown variable rates of progression to cirrhosis in patients with chronic hepatitis C according to the group analyzed. Only 2% of women contaminated through the use of immunoglobulin evolved to cirrhosis over a follow-up period of 17 years [2], while cirrhosis was observed in 51% of patients contaminated through blood transfusion [3].During cirrhosis, patients may develop complications secondary to portal hypertension and/or hepatic insufficiency; they may also have a higher risk for hepatocellular carcinoma (2 to 4% per year) [4,5]. These complications are intimately related to the degree of fibrosis and destructuring of the lobular architecture and, therefore, staging represents the main prognostic marker in patients with chronic hepatitis C.Knowledge about the factors that influence the natural history of hepatitis C is important for the clinical treatment of patients and for the implementation of preventive and therapeutic measures.Our objective was to assess the effect of hostrelated factors on the histological manifestations of

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Section: Discussionsupporting

confidence: 67%

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Costa¹,

Ferraz²,

Perez³

et al. 2002

Braz J Infect Dis

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“…Of note, male gender, concomitant alcohol consumption, and HCV transmission after blood transfusion have been identified as potential risk factors for an aggressive course of HCV infection, whereas female gender and young age at infection have been associated with a benign course of HCV infection. 7,21,22 Current projections predict that the prevalence of HCV-related ESLD and its associated complications will continue to increase in patients older than 60 years. 23 Fibrosis progression has been shown to be nonlinear and stage specific, likely accelerating after prolonged disease duration.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of liver disease progression in the German hepatitis C virus (1b)-contaminated anti-D cohort at 35 years after infection

Wiese¹,

Fischer

Löbermann

et al. 2013

Hepatology

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The natural course of HCV infection remains controversial. The German HCV (1b)-contaminated anti-D cohort provides an ideal population to investigate the natural course of HCV infection in a large, homogenous cohort of young women from the date of HCV inoculation. Our previous follow-up studies at 20 and 25 years after infection suggested slow fibrosis progression rates in this unique cohort. The aim of our prospective, community-based, multicenter study was to reevaluate the liver disease progression in 718 patients of the original anti-D cohort at 35 years after infection. Patients with self-limited HCV infection (n 5 189) were compared to those who failed to eliminate the virus spontaneously (n 5 529), comprising patients who were treatment na€ ıve (n 5 197) or achieved a sustained virological response (SVR; n 5 149), respectively, failed to clear the virus (non-SVR; n 5 183) after antiviral therapy. In the overall cohort, 9.3% of patients showed clinical signs of liver cirrhosis at 35 years after infection. Liver disease progression largely depended on HCV infection status. The highest proportion of patients with clinical signs of end-stage liver disease was observed in the non-SVR group (15.3%), whereas decreased cirrhosis rates were detected in the SVR group (6%) and in patients with self-limited HCV infection (1.1%; P 5 6.2 3 10 26 ). Overall survival was significantly enhanced after SVR, compared to treatment-na€ ıve patients or non-SVR (P 5 0.027). Conclusion: The present study provides further evidence for a mild, but significant, disease progression at 35 years after infection in the German HCV (1b)-contaminated anti-D cohort. Patients with self-limited HCV infection or SVR after antiviral treatment were protected from progressive liver disease and showed the best clinical long-term outcome. (HEPATOLOGY 2014;59:49-57) H epatitis C virus (HCV) infection is the leading cause of end-stage liver disease (ESLD) in the world and represents a major burden for national health systems. 1 The World Health Organisation (WHO) and international consensus conferences refer to the high chronification rate of HCV infection, the risk of subsequent HCV-related complications, including end-stage liver cirrhosis and hepatocellular carcinoma (HCC) and the high costs for antiviral therapy, respectively, liver transplantation (LT). 2,3 It is estimated that HCV-related morbidity and mortality will increase in the next decade. [4][5][6] The predicted cumulative probability of cirrhosis approximates 20% at 20 years after HCV infection and

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“…19,[34][35][36] However, this difference is not surprising given the number of factors that could contribute to the progression of fibrosis and the difference in their occurrence in various settings. This study exclusively analyzed fibrosis progression among IDUs, the largest group worldwide of HCV-infected individuals and those least likely to undergo histologic evaluation of liver disease severity.…”

Section: Discussionmentioning

confidence: 99%

Progression of liver fibrosis among injection drug users with chronic hepatitis C

et al. 2006

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Although most hepatitis C virus (HCV) infections are acquired by injection drug use, prospective data on the progression of liver fibrosis are sparse. Baseline liver biopsies were obtained (1996-1998) on a random sample of 210 out of 1667 HCV-positive injection drug users (IDUs). Subjects were followed biannually, with a second biopsy offered to those eligible. Paired biopsies were scored 0 to 6 (modified Ishak score), significant fibrosis was defined as score 3 or greater, and progression of fibrosis was defined as an increase 2 or more units or clinical evidence of end-stage liver disease. Predictive values of blood markers [FibroSURE, aspartate aminotransferase-to-platelet-ratio index (APRI) and alanine aminotransferase (ALT)] were assessed for detection of contemporaneous and future liver fibrosis. Among 119 prospectively followed IDUs, 96% were African American; 97% HCV genotype 1a/b; 27% HIV-infected, and median age was 42 years. Most (90.7%) did not have significant liver fibrosis at first biopsy. Although predictive value for detecting insignificant fibrosis at first biopsy was greater than 95% for FibroSURE, APRI, and ALT, specificities were 88.9%, 72.7%, and 72.7%, respectively. After 4.2 years median follow-up, 21% had progression of fibrosis, which was significantly associated with serum level of HCV RNA and ALT. No serological test had predictive value greater than 40% for contemporaneous or future significant fibrosis. Even initial biopsy result had only a 30.4% value for predicting future significant fibrosis. In conclusion, significant liver fibrosis and progression were detected in some, but not most, IDUs in this cohort. In this setting with low fibrosis prevalence, FibroSURE, ALT, and APRI tests predict insignificant fibrosis; however, further work is needed to find noninvasive markers of significant liver fibrosis. (HEPATOLOGY 2006;43: 788-795.)

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The pathology of hepatitis C as a function of mode of transmission: Blood transfusion vs. Intravenous drug use

Cited by 117 publications

References 27 publications

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

Evaluation of liver disease progression in the German hepatitis C virus (1b)-contaminated anti-D cohort at 35 years after infection

Progression of liver fibrosis among injection drug users with chronic hepatitis C

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