Progression of initially mild hepatic fibrosis in patients with chronic hepatitis C infection

• Published in: Journal of viral hepatitis 2011-01, Vol.18 (1), p.17-22
• Main Authors: Williams, M. J., Lang-Lenton, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; age; Age Factors; Aged; alanine transaminase; Alanine Transaminase - blood; Biopsy; Child; Child, Preschool; chronic hepatitis C; Chronic infection; Disease Progression; Female; Fibrosis; Hepatitis C; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - pathology; Hepatitis C, Chronic - virology; Humans; Liver; Liver - pathology; Liver Cirrhosis - complications; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Male; Middle Aged; mild fibrosis; progression; Risk Factors; Surveys and Questionnaires; Young Adult
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2009.01262.x

A significant number of patients with chronic hepatitis C infection have minimal fibrosis at presentation. Although the short‐term outlook for such patients is good, there are limited data available on long‐term progression. We assessed the risk of fibrosis progression in 282 patients with chronic hepatitis C with Ishak stage 0 or 1 fibrosis on initial liver biopsy. Progression of fibrosis stage occurred in 118 patients (42%) over a median interval of 52.5 months. Thirteen (5%) progressed to severe (Ishak stage 4 or more) fibrosis. Progression was significantly associated with both age at initial biopsy [odds ratio (OR) for progression of 1.31 per 10 year increase in age] and median alanine transaminase (ALT) levels during follow‐up (OR of 1.06 per 10 IU/L increase). There was no significant association with gender, histological inflammatory grade, hepatic steatosis or body mass index. 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.