Progression
of Initially Mild Liver Fibrosis in People with Chronic Hepatitis
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| 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.
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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).
Results
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118
participants (42%) experienced progression of fibrosis to
a higher stage during follow-up. |
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13
patients (5%) progressed to severe fibrosis or cirrhosis (stage
4 or higher). |
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Fibrosis
progression was significantly associated with: |
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Age
at initial biopsy (odds ratio for progression 1.31 per
10 year increase); |
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Higher
ALT level during follow-up (odd ratio 1.06 per 10 IU/L
increase). |
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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.
2/2/10
Reference
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).
