Fibrosis progression in initially mild chronic hepatitis C

Abstract

The natural history of chronic hepatitis C presenting with no/minimal liver fibrosis is uncertain with controversies on risk of progression and need for antiviral treatment. We studied rates and determinants of fibrosis progression in initially mild chronic hepatitis C. One hundred and six patients (mean age 41.65 +/- 12.83 years) with chronic hepatitis C virus infection and no/minimal fibrosis in the initial liver biopsy (F0/F1 by METAVIR score) were followed prospectively while untreated with repeated biopsy after 5 or more years (mean interval 7.8 +/- 1.51 years). Patients showing fibrosis progression were compared with nonprogressors for baseline and follow-up parameters. Sixty-four patients (60.4%) showed fibrosis progression including 13 of 27 (49%) with F0 and 51 of 79 (65%) with F1. Progression to F3 or cirrhosis was seen in 36% of those with F1 initially. Fibrosis progression (DeltaF/year) was associated with age (P < 0.0001), baseline and follow-up alanine aminotransferase (ALT) (P = 0.005), histological activity (P = 0.004) and steatosis (P = 0.002) in the initial biopsy and use of alcohol (P = 0.008). Thus liver fibrosis progression occurs in two-thirds of patients with initially mild chronic hepatitis C within 5-10 years and advanced fibrosis/cirrhosis develops in one-third of those with F1 initially. Fibrosis is facilitated by older age and alcohol and associated with inflammatory activity and ALT levels. Antiviral therapy should be considered in mild chronic hepatitis C.

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

“…4,5,8,10,14,16,17,21,23 In our study, we found higher Knodell scores in patients with more severe fibrosis. The aim of our study was to predict liver fibrosis without a liver biopsy.…”

Chronic hepatitis C: pathological anatomy

“…A study involving 106 patients with initial biopsy presenting architectural staging 0 or 1 and re-biopsied after a mean interval of 7.8 years (minimum of 48 months) [48] revealed progression of architectural damage in 64 cases (60.4%), suggesting the need for therapeutic intervention, even in infected individuals not yet presenting significant alterations to the hepatic architecture. Among the predictive factors for progression of the injury, those authors highlight the level of necroinflammatory activity: 31.2% of the cases with moderate activity (A2) presented progression, which only occurred in 2.3% of those without activity (A0) and the presence of steatosis (progression in 87.5% of the cases with > 30% cells with steatosis, in 80% of those with < 30% steatosis, and in only 48.6% without steatosis).…”

“…In our view, in addition to reports on that decision, as summarized in the METAVIR, Ishak, Scheuer, and Desmet classification systems, or, among us, the SBP/Brazilian Society of Hepatology consensus led by Gayotto, most recent evidence brings back the need of a detailed report of each of the principal forms of liver damage, and there have been studies that demonstrate a more rapid evolution of cases that present, among other predictive factors, more interface activity, confluent necrosis of hepatocytes, and steatosis [47,48].…”

Disease progression in Chinese patients with hepatitis C virus RNA-positive infection via blood transfusion

“…In addition, numerous clinical trials failed to perform continuous, long-term observation of disease progression, resulting in significant differences in the rate of disease progression between various clinical trials (22)(23)(24)(25). One report showed that progression of mild fibrosis occurred over a median interval of 52.5 months, while another reported that progression of fibrosis occurred in patients with mild chronic HCV within 5-10 years after infection and was associated with age, alcohol consumption and inflammatory activity (26,27). Although children with chronic HCV showed no significant histologic progression of disease at 5 years after infection, almost a third of the children showed increased severity of Figure 1.…”