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

Abstract

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

Editorial: the burden of chronic liver disease – an ecological method sees the wood for the trees

“…In historical cohorts, where the main route of hepatitis C transmission was iatrogenic rather than Intravenous drug use, alcohol use disorders and coinfections were low and liver disease progression rates remained low over decades. 5,6 All cost-effectiveness models in hepatitis C involve a reduction of liver deaths with increasing efficacy and uptake of hepatitis C treatments. 7 However, there are potential confounders such as alcohol use disorders and comorbidities, neither of which are taken into account in these models.…”

Editorial: the burden of chronic liver disease – an ecological method sees the wood for the trees. Authors’ reply

“…3 Poly-unsaturated fatty acids, and polyphenols such as silymarin, curcumin and resveratrol have been studied in pre-clinical models and small-scale trials demonstrating reduction in markers of liver injury, inflammation, apoptosis and oxidation. 4 In a recent issue of the journal, Loffredo et al 5 have investigated the effects of dark chocolate consumption in patients with NASH. Chocolate consumption, especially dark chocolate is associated with lowering of lipid peroxidation and thereby improving cardiovascular risk.…”

“…Indeed, several cohort studies in hepatitis C infected individuals demonstrated that in the absence of risk factors (such as alcohol consumption), progression to severe liver disease may take decades or may not occur at all in the vast majority of patients. 3,4 One problem for a substantial group of patients with chronic hepatitis C is impaired quality of life (QoL). 5 Patients with advanced fibrosis have impairment in quality of life.…”

Prognosis of Liver Disorders in Dna Positive Hbv Patients Based on Fuzzy Soft Sets

“…The presence of hepatocyte death, reflected by increased of serum alanine amino transferase (ALT) and aspartate amino transferase (AST), is a widely used marker to screen and monitor patients with liver disorders. Moreover, these markers drive therapeutic decisions; have prognostic value for patients with hepatitis B virus (HBV) (Lok 2004;Lazo et al 2011;Cui et al 2013;Rehm et al 2013), and hepatitis C virus (HCV) (Wiese et al 2000;Ghany et al 2003;Hui et al 2003;Wiese et al 2014). There were also no reports on the combination of liver lobe volume with albumin to determine the presence of esophageal varices in cirrhotic patients (Ranjith et al 2003;Wiese et al 2014).…”