title: Association between age at diagnosis and degree of liver injury in hepatitis C.
abstract: BACKGROUND
  A population-based survey conducted in Brazilian capital cities found that only 16% of the population had ever been tested for hepatitis C. These data suggest that much of the Brazilian population with HCV infection remains undiagnosed. The distribution of age ranges at diagnosis and its association with the degree of hepatitis C are still unknown in Brazilian patients.
  
  
  METHODS
  Patients with HCV infection, diagnosed by HCV RNA (Amplicor-HCV, Roche), were included in the study. Patients with HBV or HIV coinfection, autoimmune diseases, or alcohol intake>20 g/day were excluded. HCV genotyping was performed by sequence analysis, and viral load by quantitative RT-PCR (Amplicor, Roche). The METAVIR classification was used to assess structural liver injury. The Chi-square (χ(2)) test and student's t-test were used for between-group comparisons. Spearman's rank correlation coefficient were used for analysing the correlation between parameters.
  
  
  RESULTS
  A total of 525 charts were reviewed. Of the patients included, 49.5% were male, only 10% of the patients were aged less than 30 years; peak prevalence of HCV infection occurred in the 51-to-60 years age range. Genotype 1 accounted for 65.4% of the cases. Information on HCV subtype was obtained in 227 patients; 105 had subtype 1a and 122 had 1b. According to the degree of structural liver injury, 8.3% had F0, 23.4% F1, 19.8% F2, 11.9% F3, and 36.5% F4. Age at diagnosis of hepatitis correlated significantly with fibrosis (rs=0.307, p<0.001). The degree of fibrosis increased with advancing age. Only age at diagnosis and fasting blood glucose were independently associated with disease stage. Those patients with subtype 1a had higher prevalence of F2-F4 than those with subtype 1b.
  
  
  CONCLUSIONS
  In Brazil, diagnosis of hepatitis C is more commonly established in older patients (age 45-60 years) with more advanced disease. Reassessment of strategies for hepatitis C diagnosis in the country is required.
authors.affiliation: Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil. Electronic address: anaol@terra.com.br.
authors.forename: Ana Cláudia de
authors.initials: AC
authors.lastname: Oliveira
authors.affiliation: Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
authors.forename: Ana Clara
authors.initials: AC
authors.lastname: Bortotti
authors.affiliation: Department of Medicine, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil.
authors.forename: Nathália Neves
authors.initials: NN
authors.lastname: Nunes
authors.affiliation: Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ibrahin A H
authors.initials: IA
authors.lastname: El Bacha
authors.affiliation: Discipline of Gastroenterology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Edison Roberto
authors.initials: ER
authors.lastname: Parise
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral; D012720:Severity of Illness Index; D012737:Sex Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: Age at diagnosis; Chronic hepatitis C; Hepatic fibrosis