Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications

Abstract

Background and aims: The natural history of initially compensated cirrhosis due to hepatitis B (HBV) or hepatitis C (HCV) virus is only partially defined. We have investigated morbidity and mortality rates and the hierarchy of complications in compensated viral cirrhosis over a long follow up period. Patients and Methods: A cohort of Italian patients with initially compensated cirrhosis of viral aetiology were followed up at six monthly intervals with laboratory tests to identify major complications (ascites, gastrointestinal bleeding, portal-systemic encephalopathy, hepatocellular carcinoma) and to assess the progression of Child's stage and mortality rate due to liver related causes. Results: Between 1986 and 1996, 312 patients (43 HBV positive, 254 HCV positive, and 15 HBV and HCV coinfected) were included. During a median follow up of 93 (range 14-194) months, 102 (32.6%) patients developed at least one complication (HCV positive 31.1%; HBV positive 34.8%; HBV and HCV coinfected 53.3%). Overall, the most frequent complication was hepatocellular carcinoma which occurred in 65 (20.8%) cases, followed by ascites (61 cases, 19.5%), gastrointestinal bleeding (14 cases, 4.5%), and portal-systemic encephalopathy (six cases, 1.9%). Progression of Child's stage was observed in 62 patients (19.8%). Death from liver disease occurred in 58 (18.6%) cases and in 70.7% this was due to hepatocellular carcinoma. Hepatocellular carcinoma was the first complication to develop in 59 cases and represented the most frequent first complication in both HCV and HBV/ HCV related cirrhosis. Conclusions: These results indicate significant morbidity and mortality during the first decade after diagnosis of compensated cirrhosis due to HBV and/or HCV, and identify hepatocellular carcinoma as the most frequent and life threatening complication, particularly in HCV positive cases.

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

“…Only two of them (Benvegnu`et al, 1994;Chiaramonte et al, 1998) showed an additive synergism between the two infections, while the others (Zoli et al, 1996;Del Olmo et al, 1998;Benvegnu`et al, 2004;Sangiovanni et al, 2004) showed independence between the two infections in causing HCC.…”

Sustained virological response to interferon-α is associated with improved outcome in HCV-related cirrhosis: A retrospective study

“…29 Our data suggest that the reduction of liver-related mortality among SVR patients resulted from the combined efficacy of IFN against decompensation or bleeding and HCC, because these complications are the leading causes of death in patients with early cirrhosis due to HCV. 30,31 Data indicate that IFN may prevent the worsening of the disease by suppressing HCV-related liver inflammation which favors hepatocellular failure and the progression of portal hypertension, and by modulating several cell factors involved in neoplastic transformation, such as RNA-dependent PKR and 2Ј,5Ј oligo adenyl synthetase. 32 In murine models, IFN inhibits liver cell proliferation and stimulates apoptosis of preneoplastic hepatocytes.…”

Does chemotherapy prevent HCV-related hepatocellular carcinoma? Cons

“…compensated cirrhosis of viral aetiology, in which HCC is the first complication to occur and a major cause of liver-related death [4]. Chemoprevention may be defined as the use of natural or synthetic agents to reverse, suppress, or prevent premalignant lesions from progressing to invasive cancer [5].…”