title: Natural history of hepatic fibrosis progression in chronic hepatitis C virus infection in India.
abstract: 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.
authors.affiliation: Department of Gastroenterology, G.B. Pant Hospital, New Dehli 110002, India.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Hissar
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
authors.forename: Pankaj
authors.initials: P
authors.lastname: Tyagi
authors.forename: Ankur
authors.initials: A
authors.lastname: Goyal
authors.forename: P V
authors.initials: PV
authors.lastname: Suneetha
authors.forename: Sriram
authors.initials: S
authors.lastname: Agarwal
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: 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