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Natural
History of Chronic Hepatitis C
Pagliaro L, Peri V, Linea C,
Camma C, Giunta M, Magrin S.
Ital J Gastroenterol Hepatol.
1999 Jan;31(1):28-44.
Comment in:
Ital J Gastroenterol Hepatol.
1999
Jan-Feb;31(1):1-3 PMID: 10091095
Institute of General Medicine and
Pneumology,
University of Palermo, Italy.
BACKGROUND AND AIMS:
A comprehensive overview on the course of hepatitis C is not
available despite the many studies published. The aim was to review
the course and prognostic variables of untreated hepatitis C.
METHODS:
English-language articles published between January 1989 and
December 1997 were identified and data extracted to answer
predefined relevant questions.
RESULTS:
Median chronicization rate, mostly assessed in
transfusion-associated hepatitis, was 67%. In retrospective studies,
the interval between date of infection and diagnosis of cirrhosis or
hepatocellular carcinoma was 20-40 years. Median progression rate
from chronic hepatitis to cirrhosis was 27.9% after 8-12 years.
Studies obtaining this figure included selected groups of patients
and could reflect the worst prognostic segment of
the disease. The course of hepatitis C virus infection may be
more favourable: cirrhosis rarely or never occurred in young females
infected by contaminated anti-D-immunglobulins; hepatitis was
histologically mild in most hepatitis C virus-RNA positive subjects
with normal or near normal transminases, predicting non-progressive
or very slowly progressive disease; in a population survey from
Italy, among 170 infected subjects only 4% had raised transaminases,
and none overt liver disease. Increasing age, histological severity,
alcohol, possibly male sex and liver iron content were predictors of
cirrhosis or increased fibrosis.
CONCLUSIONS:
Chronicization rate of hepatitis C virus infection is very high.
Hepatitis C virus infection can result in a wide prognostic spectrum
of liver disease, ranging from cirrhosis and hepatocellular
carcinoma to subclinical, nonprogressive disease. Cofactors such as
alcohol excess are important in determining the outcome of hepatitis
C virus-related chronic liver disease.
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