Pathological evolution of hepatitis C virus-＂Healthy carriers

• Published in: World journal of gastroenterology : WJG 2008-06, Vol.14 (24), p.3861-3865
• Main Authors: Sobesky, Rodolphe, Lebray, Pascal, Nalpas, Bertrand, Vallet-Pichard, Anais, Fontaine, Helene, Lagneau, Jean-Luc, Pol, Stanislas
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Alanine Transaminase - blood; Biopsy; Body Mass Index; Carrier State - virology; Disease Progression; Female; Hepacivirus - genetics; Hepacivirus - pathogenicity; Hepatitis C - metabolism; Hepatitis C - pathology; Humans; Liver - enzymology; Liver - pathology; Liver - virology; Liver Cirrhosis - metabolism; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Rapid Communication; RNA, Viral - blood; Severity of Illness Index; Viral Load; 丙氨酸-转氨酶; 丙肝病毒; 肝切片检查; 肝纤维化
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.14.3861

AIM： To determine factors associated with fibrosis progression in hepatitis C virus （HCV）-infected patients without significant initial pathological lesions. METHODS： Seventy six untreated HCV-infected patients with initially normal liver as defined by a Knodell score ≤ 3, with 2 liver biopsies and detectable HCVRNA were included. Markers of fibrosis progression were assessed. RESULTS： Median duration of infection and time between paired biopsies was 13 （95% CI： 1-28） and 4 （95% CI： 2-16） years respectively. Alaninetransaminase （ALT） activity was normal in 43.4% of cases. 50% demonstrated progression of the necroinflammation and 34% of fibrosis after a median time evolution of 4 years （95% CI： 2-16）. The median difference in the necro-inflammation and fibrosis score between biopsies was low, 1.5 and 0.0 respectively. Univariate analysis showed there was no difference between fibrosis activity or evolution according to genotype or viral load. A higher fibrosis progression （P = 0.03） was observed in patients with body mass index （BMI） 〉 25. Fibrosis progression correlated with the time interval between biopsies （P = 0.01）. A significant progression of activity （1.7 vs 0.4, P 〈 0.05） or fibrosis （0.9 vs 0.0, P 〈 0.01） was observed in patients with elevated ALT. There was a significant correlation between activity progression and fibrosis progression（P = 0.003）. Multivariate analysis demonstrated that fibrosis progression was associated with elevated ALT, BMI 〉 25 and the time interval between 2 biopsies. CONCLUSION： There is no fibrosis progression in 66% of patients without significant initial histopathological lesion. Fibrosis progression is associated with elevated ALT and BMI 〉 25.