Assessment of Long-Term Outcomes of Community-Acquired Hepatitis C Infection in a Cohort With Sera Stored From 1971 to 1975

Abstract

The aim of this study was to examine the long-term effects of hepatitis C virus (HCV) infection on a cohort of patients admitted with acute viral hepatitis from 1971 through 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV-positive on admission. Sixteen percent (n ‫؍‬ 238) of the cohort tested anti-HCV-positive. The unexposed group was selected from those who were anti-HCVnegative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study-specific questionnaire and clinical, serological, virological, and biochemical assessment. Complete follow-up was achieved on 98 anti-HCV-positive individuals and 201 negatives. Injecting drug use (IDU) was the presumed route of infection. At a mean of 25 years' followup, 54% of the anti-HCV-positive group had evidence of chronic HCV infection (both anti-HCV-and HCV-RNA-positive); the remainder were HCV-RNA-negative. Sixty-nine percent of those chronically infected had elevated serum alanine transaminase (ALT) levels, but only 8% had progressed to overt cirrhosis, and no cases of hepatocellular carcinoma (HCC) were identified. In summary, anti-HCV-positive subjects were 8 times more likely to have died from suicide or drug overdose than from HCVrelated disease. Anti-HCV-positive study subjects were at increased risk of liver-related pathology after 25 years' follow-up, but few had progressed to overt cirrhotic liver disease. Excess mortality in this group was not the result of liver disease. This suggests that the natural history of community-acquired HCV may be more benign than previously thought. (HEPATOLOGY 2000;32:582-587.)

Natural history of chronic hepatitis C

“…These were made possible by the ability to identify reasonably large groups of individuals who, in the past, had developed recognized acute hepatitis C, who could be traced retrospectively, recontacted, and then followed-up prospectively. It is noteworthy that, among 7 representative such studies 6 involved young people (one, young children; 2, young women; 2, young injection drug users; one, young men with communityacquired hepatitis C), [7][8][9][10]23,24 and one, middle-aged persons who had developed transfusion-associated hepatitis C ( Table 2). 25 Study Among Young Children.…”

Host genetic determinants in hepatitis C virus infection

“…Women and individuals infected at a younger age have lower rates of chronicity. [2][3][4] Among those chronically infected, some individuals develop cirrhosis or liver cancer (hepatocellular carcinoma), while others experience little progression. 1,5,6 Some individuals with chronic HCV develop a number of extrahepatic comorbidities, ranging from autoimmune manifestations to disorders such as diabetes.…”

Clearance of hepatitis C virus RNA from the peripheral blood mononuclear cells of blood donors who spontaneously or therapeutically control their plasma viremia

“…[1][2][3][4][5][6] Combination antiviral therapies can also achieve sustained virological response, defined as persistent clearance of plasma viremia, in a growing fraction of treated patients. Numerous publications have analyzed extrahepatic compartments of viral replication that could potentially contribute to plasma viremia, most frequently peripheral blood mononuclear cells (PBMC).…”