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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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