title: Hepatitis activity index is a key factor in determining the natural history of chronic hepatitis C.
abstract: To analyze the spontaneous pathologic progression of chronic hepatitis C, we analyzed the histopathologic semiquantitative scores (Metavir and Knodell) of sequential liver biopsies performed in untreated hepatitis C virus (HCV)-infected patients. Subjects included 35 men and 41 women, with a mean age of 41 +/- 12 years, a duration of HCV infection of 11 +/- 5 years, and an interval between liver biopsies of 3.7 +/- 2.5 years. Results obtained using the Knodell score and the Metavir score were similar. At the first biopsy, 78.9% of patients had a low activity score (A0-A1) and 82.9% had a low fibrosis score (F0-F2). At the second biopsy, the activity decreased in 9.2%, was unchanged in 72.4%, and increased in 18.5%. An increase in activity was more frequently observed in patients infected with genotype 1 (28.9%) than with others (7.7%; P =.04); the yearly progression of activity was significantly higher in patients with a low rather than high initial activity score (0.11 v -0.02; P <.01). An increase in fibrosis was noted in 13.3% of those with a low and 43.8% of those with a high initial activity score (P <.01), with a highest rate of yearly fibrosis progression (0.12 U). In multivariate analysis, only a high activity score was significantly associated with an increased risk of fibrosis progression (relative risk, 25.5; 95% confidence interval, 2.7 to 238; P =.004). Spontaneous chronic hepatitis C evolution is worsening in only 20% of patients. Fibrosis progression is significantly associated with the necroinflammatory activity suggesting that this factor should be regarded as a major clue for deciding therapy.
authors.affiliation: Unité d'Hépatologie and INSERM U370, Hôpital Necker, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Fontaine
authors.forename: B
authors.initials: B
authors.lastname: Nalpas
authors.forename: B
authors.initials: B
authors.lastname: Poulet
authors.forename: F
authors.initials: F
authors.lastname: Carnot
authors.forename: H
authors.initials: H
authors.lastname: Zylberberg
authors.forename: C
authors.initials: C
authors.lastname: Brechot
authors.forename: S
authors.initials: S
authors.lastname: Pol
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000914:Antibodies, Viral / Q000032:analysis; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D012367:RNA, Viral / Q000032:analysis
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral; D000410:Alanine Transaminase