Assessment of fibrosis progression in untreated irish women with chronic hepatitis C contracted from immunoglobulin anti-D.
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.
Levine
Robert A
RA
State University of New York, Upstate Medical University, Syracuse, New York 13210, USA. leviner@upstate.edu
Sanderson
Schuyler O
SO
Ploutz-Snyder
Robert
R
Murray
Frank
F
Kay
Elaine
E
Hegarty
John
J
Nolan
Niamh
N
Kelleher
Dermot
D
McDonald
George
G
O'Keane
J Conor
JC
Crowe
John
J
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
D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin