Progression of hepatic fibrosis in viral hepatitis C after seroconversion
The frequency and risk factors leading to progression of hepatic fibrosis and decompensation of hepatic function in patients infected with hepatitis C virus have been determined.
Knowing how often liver fibrosis progresses in patients infected with hepatitis C virus (HCV) can help educate patients and clinicians about the right treatment tactics.
The objective of the study, published in the journal JAMA Internal Medicine, was to determine the frequency and risk factors leading to the progression of hepatic fibrosis and the occurrence of hepatic decompensation in patients infected with the hepatitis C virus.
The study performed a secondary analysis of patient data available in an electronic cohort of patients infected with the hepatitis C virus (cohort of veterans infected with HCV, recovered electronically - ERCHIVES), for the period from 2002 to 2012. Among 610,514 individuals, those who were not initially infected with the hepatitis C virus were identified in the ERCHIVES database, then they showed antibodies against the hepatitis C virus and the result of the virus RNA (HCV +) determination was positive.
In the group, the results for anti-HCV antibodies (HCV) were twice negative and were divided in the ratio 1: 1 by age (with an interval of 5 years), race and sex. Patients infected with HIV, hepatitis B virus, people with a follow-up period of less than 24 months, with hepatocellular carcinoma and cirrhosis at the initial visit were excluded from the study.
The progression of hepatic fibrosis was assessed by the fibrosis-4 index (FIB-4); the development of cirrhosis, cirrhosis, defined on the FIB-4 scale as greater than 3.5, and the development of decompensation of liver function.
The group evaluated included 1840 individuals HCV +, the control group - 1840 individuals without HCV. It turned out that HCV + patients were younger and had a lower body mass index compared to HCV individuals (27.39 vs 29.49; P less than 0.001). HCV + patients had a higher frequency of alcohol and drug abuse and were more often diagnosed with addiction; HCV + also had higher levels of liver transaminases, however, the incidence of diabetes and hypertension was lower. The progression of fibrosis started early after infection in HCV + patients and decreased after 5 years. A total of 452 cases of cirrhosis and 85 cases of liver function decompensation were recorded during the study. After 10 years of follow-up, HCV + individuals were more likely to be diagnosed with cirrhosis than HCV controls (18.4 vs 6.1%). 9 years after the diagnosis of cirrhosis of the liver was established, cases of development of hepatic decompensation were uncommon, but a higher frequency was in the group of HCV + patients (1.79% vs 0.33%).
Thus, patients with HCV seroconversion have a faster progression of hepatic fibrosis and a shorter period of time before the development of cirrhosis after seroconversion compared to HCV control. The progression of fibrosis occurred quickly after infection, but decompensation of liver function after a diagnosis of cirrhosis was uncommon.