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Progression of Initially Mild Liver Fibrosis in People with Chronic Hepatitis

SUMMARY: People with chronic hepatitis C who have absent or mild liver fibrosis early in the course of disease can go on to develop advanced liver damage, according to a study described in the January 18, 2010 advance online edition of the Journal of Viral Hepatitis. Study investigators suggested that older patients and those with high alanine transaminase (ALT) levels should consider early antiviral therapy, as they are at higher risk for disease progression.

By Liz Highleyman

Over years or decades, a proportion of people with chronic hepatitis C virus (HCV) infection will go on to develop advanced liver disease, including cirrhosis and hepatocellular carcinoma. Patients with progressive disease require antiviral treatment, but clinicians cannot tell in advance who will progress, and therefore who would benefit from therapy.

Investigators with the Trent HCV Study Group in the U.K. looked at long-term outcomes among hepatitis C patients who presented with minimal liver damage. The short-term prognosis for such individuals is favorable, the researchers noted as background, but there are limited data on long-term progression.

The analysis included 282 chronic hepatitis C patients with absent (Ishak stage 0) or mild (stage 1) fibrosis according to an initial liver biopsy. Participants were followed for a median duration of 52.5 months (more than 4 years).


118 participants (42%) experienced progression of fibrosis to a higher stage during follow-up.
13 patients (5%) progressed to severe fibrosis or cirrhosis (stage 4 or higher).
Fibrosis progression was significantly associated with:
Age at initial biopsy (odds ratio for progression 1.31 per 10 year increase);
Higher ALT level during follow-up (odd ratio 1.06 per 10 IU/L increase).
There were no significant associations between fibrosis progression and sex, body mass index, histological inflammatory grade, or liver steatosis (fat accumulation).

Based on these findings, the study authors wrote, "We conclude that hepatitis C with initially mild fibrosis does progress in a substantial proportion of patients and should not be viewed as a benign disease. Early antiviral therapy should be considered in older patients and those with high ALT levels."

While this study showed that elevated ALT was a risk factor for fibrosis progression, other research has shown that liver disease does progress in some people with persistently normal ALT. Conversely, this study did not find an association with body weight or steatosis, as observed by other researchers.

Nottingham Digestive Diseases Centre, Nottingham University Hospital, Nottingham, UK.


MJ Williams and M Lang-Lenton (Trent HCV Study Group). Progression of initially mild hepatic fibrosis in patients with chronic hepatitis C infection. Journal of Viral Hepatitis (Abstract). January 18, 2010 (Epub ahead of print).






















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