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.
Tanaka
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Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan. etanaka@hsp.md.shinshu-u.ac.jp
Kiyosawa
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K
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