Epidemiological factors affecting the severity of hepatitis C virus-related liver disease: A French survey of 6,664 patients

Abstract

analysis followed by stepwise logistic regression analysis. Cirrhosis is a frequent and severe event in the course of Among the patients enrolled, 21.4% had biopsy-proven cirrhochronic hepatitis C, but it is unclear why some patients desis. Prevalence of cirrhosis markedly varied according to the velop cirrhosis after a given period whereas others do not.route of transmission of HCV. It was significantly more freWe studied a large cohort of patients with chronic hepatitis quent in blood recipients (23.4%) than in drug users (7.0%). C to determine the role of the route of transmission of hepatiAlthough the occurrence of cirrhosis was dependent on distis C virus (HCV) in the onset of cirrhosis. Six thousand six ease duration, it remained more frequent in blood recipients hundred sixty-four patients were enrolled in a nationwide than in drug users for a given duration. Apart from the route survey of chronic hepatitis C in France. We first randomly of transmission, excessive alcohol intake was also associated defined a representative sample of 30 hospitals with medical with a higher risk of cirrhosis (34.9% vs. 18.2%; P õ .001), units managing patients with HCV infection. All patients with and so was HBV infection (24.6% vs. 21.1%; P õ .05). These chronic hepatitis C were enrolled if hepatitis C was diagnosed factors acted independently of the route of transmission. Heor treated in these units in 1991, 1992, or 1993. A questionpatocellular carcinoma was observed in 3.6% of all patients naire was filled in from the patients' charts and covered demoand in 17.8% of cirrhotic patients, and its occurrence was graphic data, risk factors for HCV infection, clinical and hisstrongly and mainly related to the presence of cirrhosis. In tological data, hepatitis B virus (HBV) and human conclusion, cirrhosis occurred in about 20% of the HCV-inimmunodeficiency virus status, and alcohol intake. Descripfected patients in this study and was more frequent in blood tive statistics were prepared, and factors potentially related recipients than in drug users, independently of disease durato the onset of cirrhosis were identified by means of univariate tion. Expected changes in the epidemiology of HCV infection might modify the risk of developing cirrhosis and, thereafter, cancer. (HEPATOLOGY 1997;26:485-490.)

Daily Cannabis Smoking as a Risk Factor for Progression of Fibrosis in Chronic Hepatitis C *

“…Older age at infection and chronic excessive alcohol intake are consistently considered primary determinants of fibrosis progression, 4,6,7,20,23,24 and the relationship between fibrosis stage and necroinflammatory grade has been documented in both longitudinal and cross-sectional studies. 3,12,25,26 Steatosis is also a recognized factor associated with severe fibrosis 11,27,28 and emerged as an independent predictor of FPR in our study, while being close to significance for the prediction of severe fibrosis.…”

“…Age at infection was estimated from the first exposure to IVDU, blood transfusion or to a known nosocomial route of transmission, as in previous studies. 6,7,20 Duration of infection was estimated as the difference between the date of infection and the date of liver biopsy. Alcohol, cannabis, and tobacco consumptions were recorded in detail over the span of HCV infection.…”

“…Well-accepted factors associated with fibrosis progression include sex, older age at exposure, prolonged duration of infection, excessive alcohol drinking, liver necroinflammatory response, and long-term immune supression. [2][3][4][5][6][7][8] Other parameters have been recently unearthed or remain controversial, such as steatosis, overweight, diabetes, and tobacco use. [9][10][11][12] Nevertheless, progression of fibrosis may occur in the absence of any identified profibrogenic factor, therefore warranting further research in that field.…”

Hepatitis C viral infection in the immunosuppressed patient

“…In a further study of non-A, non-B hepatitis in patients with hypogammaglobulinaemia who received hepatitis C infected immunoglobulin G, 3 of 12 (25%) developed cirrhosis within 5 years of infection. 6 In immunocompetent subjects, factors recognized as associated with more progressive hepatitis C, namely in males, the onset of infection Ͼ40 years and alcohol intake Ͼ50 g/day 7 were not relevant in these studies of hypogammaglobulinaemic patients infected with hepatitis C. 3,4 While initial infecting viral load may be important, 8 other viral factors, such as HCV quasispecies, have not been studied in these patients.…”

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

“…Some factors identified in individual studies are associated with a greater progression of liver fibrosis: length of infection, age at the time of infection, male gender, abuse of alcohol (3,7), co-infection with hepatitis B virus (8) and with human immunodeficiency virus (HIV) (9), and the presence of elevated alanine aminotransferase (ALT) (10,11). The natural history of liver fibrosis progression in patients with HCV/HIV co-infection has been studied during the last decade.…”