title: Assessment of fibrosis progression in untreated irish women with chronic hepatitis C contracted from immunoglobulin anti-D.
abstract: OBJECTIVE
  In 1996 we initiated a retrospective-prospective study in 184 untreated women infected in 1977 with chronic hepatitis C virus (HCV). To provide insight into the natural history of HCV, we determined liver fibrosis outcomes and any predictors of such.
  
  
  METHODS
  Baseline 1994 biopsy specimens (size, >or=15 mm; portal areas, >or=5) and sequential biopsy specimens were assessed by Ishak score for grade change (increase or decrease of >or=2 points) and stage progression or regression (increase or reduction of >or=1 point), the latter correlated with digital quantification of fibrosis percentage.
  
  
  RESULTS
  No baseline biopsy specimens had cirrhosis, therefore all could potentially progress. Grade and stage scores decreased or increased significantly in 28% and 18% and 24% and 27% of patients, respectively. There was a positive correlation between baseline and sequential grade/stage scores (r = .39, P < .001), and between semiquantitative Ishak scores and fibrosis percentage (Spearman rho = .85; P < .01). Baseline alanine transaminase values (mean, 49 U/L; range, 23-363 U/L) correlated positively with changes in grade (r = .41, P < .01) and stage (r = .39, P < .01), and regression analyses indicated that baseline alanine transaminase value was a good predictor of such changes. Confounding variables (alcohol, smoking, and herbal and paracetamol [acetaminophen] use) did not correlate with histologic outcomes.
  
  
  CONCLUSIONS
  In a follow-up study, 49% of patients showed no change in fibrosis, 24% showed regression, and only 27% showed progression, including 4 patients (2.1%) who developed stage 6 cirrhosis. Unidirectional sequential grade/stage concordance attested to biopsy sample reliability. Given the current age of these women in their fifth decade, some still may have a risk for more advanced liver disease, but for most of these patients it appears unlikely.
authors.affiliation: State University of New York, Upstate Medical University, Syracuse, New York 13210, USA. leviner@upstate.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.forename: Schuyler O
authors.initials: SO
authors.lastname: Sanderson
authors.forename: Robert
authors.initials: R
authors.lastname: Ploutz-Snyder
authors.forename: Frank
authors.initials: F
authors.lastname: Murray
authors.forename: Elaine
authors.initials: E
authors.lastname: Kay
authors.forename: John
authors.initials: J
authors.lastname: Hegarty
authors.forename: Niamh
authors.initials: N
authors.lastname: Nolan
authors.forename: Dermot
authors.initials: D
authors.lastname: Kelleher
authors.forename: George
authors.initials: G
authors.lastname: McDonald
authors.forename: J Conor
authors.initials: JC
authors.lastname: O'Keane
authors.forename: John
authors.initials: J
authors.lastname: Crowe
mesh_terms: D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin