Progression to cirrhosis in hepatitis C patients: an age-dependent process.
BACKGROUND
Age at infection is known to be associated with disease progression rate in hepatitis C virus (HCV) infected patients. The aim of this study was to assess when cirrhosis is expected to occur according to host and viral factors.


METHODS
Fibrosis progression was studied in 247 naive HCV patients using multiple regression analysis. The expected age at cirrhosis was calculated for each patient.


RESULTS
Progression rate was 0.13, 0.14, 0.27, and 0.36 U of fibrosis/year for patients with age at infection <or=19, 20-24, 25-36 and >or=37 years, respectively. Age at infection above 37 years was independently associated with fast progression (rate>0.13; P=0.001). Body mass index >25 kg/m2 and alanine aminotransferase>3 x ULN are also possibly associated with faster progression. Based on progression rates, the expected age at cirrhosis is 65.4, 64.6, 64.8 and 69.4 years for age at infection <or=19, 20-24, 25-36, >or=37 years, respectively.


CONCLUSIONS
Most HCV patients, if untreated, are expected to develop cirrhosis at about 65 years, irrespective of the age at infection. Thus, age itself seems even more important than age at infection for predicting the occurrence of liver cirrhosis. A specific active monitoring and therapeutic approach should be adopted in older patients to prevent progression to cirrhosis and its complications.
Pradat
Pierre
P
Department of Hepatogastroenterology, Hôtel-Dieu, Lyon, France. pradat@univ-lyon1.fr
Voirin
Nicolas
N
Tillmann
Hans Ludger
HL
Chevallier
Michèle
M
Trépo
Christian
C
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000428:Alcohol Drinking; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged
D000410:Alanine Transaminase