title: Fibrosis Progression in Patients With Chronic Hepatitis C Virus Infection.
abstract: Fibrosis progression varies markedly in hepatitis C virus (HCV)-infected individuals. We investigated factors that influence fibrosis progression in chronic HCV infection.
  
  
  
  HCV-infected patients who underwent at least 2 liver biopsies were included in this study. Associations between fibrosis progression and epidemiologic, virologic, and disease-associated factors were analyzed using logistic regression and multistate Markov modeling.
  
  
  
  We analyzed 936 biopsy specimens obtained from 378 individuals. Mean age (±SD) at first biopsy was 48.3 ± 9.3 years, 59.3% of patients were male, 59.9% were white, and 86.7% were infected with HCV genotype 1. Fibrosis progression and cirrhosis occurred in 57.4% and 5.8%, respectively. Fibrosis progression between the first and last biopsies was associated with lower fibrosis in the first biopsy specimen (P < .001) and with the occurrence of at least 1 flare in the alanine aminotransferase (ALT) level (>200 U/L; P = .007). We found the highest fibrosis progression rate between stages 0 and 1 and the lowest between stages 2 and 3. Increased necroinflammation and higher ALT level were associated with faster progression. HCV genotype 3-infected patients were more likely to progress to cirrhosis (P < .001).
  
  
  
  Fibrosis progression in HCV is not linear but varies according to stage, with the highest progression in patients with the lowest fibrosis severity. Patients who experience flares in the ALT level are also more likely to progress.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College.
authors.forename: Marija
authors.initials: M
authors.lastname: Zeremski
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine Department of Biostatistics, State University of New York, Buffalo.
authors.forename: Rositsa B
authors.initials: RB
authors.lastname: Dimova
authors.affiliation: Institute for Biotechnology, Cornell University, Ithaca, New York.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Pillardy
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College.
authors.forename: Ype P
authors.initials: YP
authors.lastname: de Jong
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Jacobson
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Talal
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy / Q000379:methods; D018450:Disease Progression; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000473:pathology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000235:genetics
chemical_list: D012367:RNA, Viral; D000410:Alanine Transaminase
keywords: alanine aminotransferase; cirrhosis; liver biopsy; liver disease progression; viral hepatitis