Natural history of hepatic fibrosis progression in chronic hepatitis C virus infection in India.
OBJECTIVE
The rate of fibrosis progression per year can predict the time for the development of cirrhosis in chronic hepatitis C (CHC). We assessed the rate of fibrosis progression and the predictors of disease severity in Indian CHC patients.


METHODS
Of the 355 treatment-naïve, histologically-proven CHC patients, the precise duration of infection (from the time of exposure to HCV until liver biopsy) could be determined in 213 patients (age = 41.6 +/- 14.7 years, male : female = 139 : 74, genotype 3 = 75%). The rate of fibrosis progression per year was calculated. The correlation of the advanced degree of fibrosis and age, duration of infection, age at the onset of infection, sex, mode of infection, hepatitis C virus (HCV) genotype, histological activity index (HAI), and the presence of diabetes mellitus were studied.


RESULTS
The median rate of fibrosis progression per year was 0.25 (0.0-1.5) fibrosis units. The fibrosis progression rate was higher in patients who acquired infection at > 30 years of age, those < 30 years (0.33 vs 0.15; P < 0.001), and those who acquired HCV infection with a history of blood transfusion than with other modes of transmission (0.25 vs 0.19; P = 0.04). The median time to progress to cirrhosis was 16 years. The multivariate analysis found that the HAI score (odds ratio [OR]= 14.03; P < 0.001) and the duration of infection > 10 years (OR = 4.83; P < 0.001) correlated with severe liver disease (fibrosis > or = 3).


CONCLUSIONS
The median rate of fibrosis progression per year in Indian CHC patients is 0.25 fibrosis units. A higher HAI and longer duration of infection are associated with a significant risk of advanced liver disease, and merit early therapeutic interventions.
Hissar
Syed S
SS
Department of Gastroenterology, G.B. Pant Hospital, New Dehli 110002, India.
Kumar
Manoj
M
Tyagi
Pankaj
P
Goyal
Ankur
A
Suneetha
P V
PV
Agarwal
Sriram
S
Rastogi
Archana
A
Sakhuja
Puja
P
Sarin
Shiv K
SK
D000328:Adult; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007194:India / Q000453:epidemiology; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors