Natural history of HCV infection.
Chronic hepatitis C virus (HCV) infection affects 170 million individuals worldwide. These individuals are at risk of developing both hepatological and non-hepatological manifestations. HCV is usually only fatal when it leads to cirrhosis, the final stage of liver fibrosis. Therefore, an estimate of fibrosis progression represents an important surrogate end-point for the evaluation of the vulnerability of an individual patient. In untreated patients, the median expected time to cirrhosis is 30 years; 33% of patients have an expected median time to cirrhosis of less than 20 years and 31% will only progress to cirrhosis after more than 50 years, if ever. Several factors are associated with fibrosis progression rate: duration of infection, age, male gender, consumption of alcohol, HIV co-infection and low CD4 count. Non-hepatological manifestations are frequent with more than 70% of HCV patients experiencing fatigue or at least one extrahepatic clinical manifestation involving primarily the joints, skin and muscles. Several immunological abnormalities are frequently observed, including cryoglobulins (40%),anti-nuclear antibodies (10%) and anti-smooth muscle antibodies (7%). In contrast severe extrahepatic manifestations are rare, with 1% for systemic vasculitis.
Poynard
T
T
Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. tpoynard@teaser.fr
Ratziu
V
V
Benhamou
Y
Y
Opolon
P
P
Cacoub
P
P
Bedossa
P
P
D000974:Antibodies, Antinuclear / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D003449:Cryoglobulinemia / Q000097:blood / Q000209:etiology / Q000276:immunology; D003450:Cryoglobulins / Q000378:metabolism; D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000150:complications / Q000276:immunology / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors
D000974:Antibodies, Antinuclear; D015415:Biomarkers; D003450:Cryoglobulins