Natural history of hepatitis C and the impact of anti-viral therapy.
The hepatitis C virus (HCV) infects some 170 million people worldwide and is responsible for approximately 20% of cases of acute hepatitis and 70% of cases of chronic hepatitis. Acute hepatitis is icteric in only 20% of patients and is rarely severe. Eighty five per cent of the infected patients develop chronic infection which is generally asymptomatic. Among the HCV chronic carriers, 25% have persistently normal serum alanine aminotransferase (ALT) levels despite having detectable HCV-ribonucleic acid in serum, 75% have elevated ALT levels. While the majority of patients with mild chronic hepatitis have a slowly progressive liver disease, the patients with moderate or severe chronic hepatitis may develop cirrhosis within a few years. In patients with HCV-related cirrhosis, the incidence of hepatocellular carcinoma is 2-5% per year. HCV-related end-stage cirrhosis is currently the first cause of liver transplantation. Treatment with the combination of interferon-alpha and ribavirin induces a sustained virological response in roughly 40% of the patients. The virological response is associated with a biochemical response and histological improvement. It is believed that the decrease of necroinflammatory liver lesions induced by anti-viral therapy in responders, is associated with a decreased risk of development of cirrhosis and hepatocellular carcinoma
Boyer
N
N
Department of Hepatology, Claude Bernard Research Centre for Viral Hepatitis and INSERM U-481, Beaujon Hospital, Clichy, France.
Marcellin
P
P
D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000821:virology; D002353:Carrier State / Q000201:enzymology / Q000503:physiopathology; D018450:Disease Progression; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy / Q000503:physiopathology*; D019698:Hepatitis C, Chronic / Q000201:enzymology / Q000503:physiopathology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D012254:Ribavirin; D000410:Alanine Transaminase