Is severe liver disease a common outcome for people with chronic hepatitis C?
For people with chronic hepatitis C, an assessment of their risk of progression to advanced liver disease is a major priority. Early studies of the natural history of chronic hepatitis C suggested that development of cirrhosis was a relatively common outcome, even in the first 20 years of infection. These studies were either cross-sectional liver clinic series of people referred for assessment to specialist clinics, or longitudinal cohorts of people with post-transfusion hepatitis. More recent studies (particularly longitudinal community-based cohorts) indicate that liver disease progression is generally slow, and that a minority of people with chronic hepatitis C will develop advanced liver disease. Based on an extensive review of studies reporting on chronic hepatitis C natural history, we have developed a Markov model of liver disease progression. This model estimates that the risk of progression to cirrhosis is 7% and 20% after 20 and 40 years of infection, respectively. Corresponding estimates for hepatitis C-related mortality are 1% and 4%. However, liver disease progression is highly variable, and certain subgroups of people with chronic hepatitis C are at increased risk of advanced liver disease. Those groups include people with a heavy alcohol intake, those who have coinfection with HIV or HBV, and those who have already progressed to moderate to severe hepatic fibrosis.
Dore
Gregory J
GJ
National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, 376 Victoria Street Level 2, Darlinghurst, Sydney, New South Wales 2010, Australia. gdore@nchecr.unsw.edu.au
Freeman
Anthony J
AJ
Law
Matthew
M
Kaldor
John M
JM
D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000503:physiopathology* / Q000821:virology*; D008390:Markov Chains; D012720:Severity of Illness Index; D065227:Transfusion Reaction