Natural history of acute hepatitis C.
To study the short- and long-term outcomes of acute hepatitis C, three groups of patients were enrolled. Of 26 patients with acute hepatitis C, 18 (69%) maintained HCV viraemia and 8 had cleared virus naturally at 12 months after the onset. Normalization of ALT was seen in all 8 patients with acute resolving hepatitis, but in only 1 (5%) of the 18 patients with chronic HCV infection (P< 0.001). Changes in liver histology were analysed in 43 patients with acute hepatitis C who underwent repeated liver biopsy. The mean score of the fibrotic stage was 0.9 within 1 year of the onset, and it increased gradually up to 3.5 at 30 years from the onset (0.1 grade/year). The fibrotic stage increased more rapidly in patients aged more than 50 years. In 115 patients, the mean duration between blood transfusion and the diagnosis of HCC increased significantly (P< 0.001) in accordance with increasing age at blood transfusion; 35 +/- 5.3 years in patients aged less than 30 years, 30 +/- 4.9 years in those aged between 30 and 40 years, and 25 +/- 6.8 years in those aged more than 40 years. In conclusion, approximately 70% of patients with acute hepatitis C develop chronic hepatitis. Once patients develop chronic hepatitic fibrosis of the liver, it progresses over several decades, faster in older patients.
Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan. etanaka@hsp.md.shinshu-u.ac.jp
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D000208:Acute Disease; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D018450:Disease Progression; D006526:Hepatitis C / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology; D012698:Serologic Tests