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OUTCOME OF INITIALLY MILD CHRONIC HEPATITIS C

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  • claudine intexas
    NATAP - www.natap.org ... AASLD Dallas, Nov 9-13 Reported by Jules Levin abstract 205. OUTCOME OF INITIALLY MILD CHRONIC HEPATITIS C: after 8 year biopsy
    Message 1 of 2 , Dec 5, 2001
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      NATAP - www.natap.org
      ----------------------

      AASLD
      Dallas, Nov 9-13
      Reported by Jules Levin

      abstract 205. OUTCOME OF INITIALLY MILD CHRONIC
      HEPATITIS C: after 8 year biopsy followup 40% showed
      no fibrosis progression, 13% had cirrhosis, 33%
      progressed from F1 to F2 and 16% from F1 to F3

      Alfredo Alberti, Silvia Boccato, Alessia Ferrari,
      Luisa Benvegnu, Patrizia Pontisso, Franco Noventa,
      Angelo Gatta, Dept of Clin and experimental medicine,
      Padova Italy

      (editorial note: one point the authors do not address
      is when the patients contracted HCV. The duration of
      having HCV may play a role in the progression rates.
      Progression rates do not appear to be the same over
      years. Patients who have had HCV for many years may
      progress more quickly than patients with HCV for just
      several years. In HCV/HIV coinfection studies show
      progression is quicker. So, in this study 29% of
      patients who initially had mild liver disease
      progressed to cirrhosis or the stage of their disease
      progressed within 8 years. So, progression in HIV may
      take less years. Many treating physicians feel that a
      coinfected patient with F2 really should be considered
      an F3 stage case. They add one stage to their biopsy
      result).

      Abstract:
      The long term outcome of initially mild chronic
      hepatitis C, defined on the basis of minimal fibrosis
      in the liver, is controversial and markers to predict
      progression are still undefined. One hundred and five
      patients (58 males and 47 females; mean age at initial
      diagnosis 42 years) with initially mild chronic
      hepatitis C (fibrosis score F1 or less and activity
      score A2 or less by METAVIR) were evaluated again with
      a second liver biopsy after a mean follow-up period of
      8.3 years (range 7 to 11 years). None of the 105 cases
      had received treatment with interferon or with
      interferon and ribavirin during this time interval.
      Thirty-three patients had persistently normal ALT
      levels while 72 had persistently abnormal or
      fluctuating ALT.

      Fourteen patients (13%) had histological evidence of
      cirrhosis in the follow-up biopsy, all being
      clinically and biochemically well compensated.
      Progression of liver fibrosis score was observed in 49
      additional cases (46.6%) (33 to F2 and 16 to F3) while
      42 patients (40%) showed no fibrosis progression.
      Fibrosis was increased in the follow-up biopsy in 52
      out of 72 (72%) patients with elevated ALT (14
      developed cirrhosis, 14 progressed to F3 and 24 to F2)
      and in 11 out of 33 (33%) cases with persistently
      normal ALT (2 progressed to F3 and 9 to F2). Mean
      fibrosis progression was 0.14/year in the former and
      0.07/year in the latter group. By multivariate
      analysis, fibrosis progression correlated with age at
      diagnosis (p=0.02), mean ALT levels during follow-up
      (p= 0.001), alcohol intake > 40 gr/day(p= 0.05) ,
      necroinflammatory activity (p=0.02) and steatosis
      (p=0.05)in the initial biopsy. Patients with mean ALT
      levels > 100 IU/L or > 150 IU/L showed a relative risk
      of fibrosis progression of 3.4 and 5.1 respectively
      compared to cases with lower ALT levels. On the other
      hand fibrosis progression was independent of the HCV
      genotype and viral load. In conclusion, more than 50%
      of patients with initially mild chronic hepatitis C
      have a progression of fibrosis over a decade and
      around 30% may develop advanced fibrosis or
      compensated cirrhosis. Progression of fibrosis
      correlates with necroinflammatory activity in the
      initial biopsy and with the ALT profile during
      follow-up, being accelerated in older patients and in
      those with liver steatosis or significant alcohol
      intake.


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    • alleypat
      ... wrote: OUTCOME OF INITIALLY MILD CHRONIC ... Excellent article claudine! I particularly like the part that viral load and gentoype
      Message 2 of 2 , Dec 5, 2001
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        --- In GIWorld-Hepatitis@y..., claudine intexas
        <claudineintexas@y...> wrote: OUTCOME OF INITIALLY MILD CHRONIC
        > HEPATITIS C: after 8 year biopsy followup 40% showed
        > no fibrosis progression, 13% had cirrhosis, 33%
        > progressed from F1 to F2 and 16% from F1 to F3 >>

        Excellent article claudine! I particularly like the part that viral
        load and gentoype had no determining factor in their progression.

        Thanks for the post :)

        alley
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