The hepatitis C-positive patient

Chapter 35 THE HEPATITIS C-POSITIVE PATIENT





EPIDEMIOLOGY







CLINICAL COURSE OF HCV INFECTION





Complications of chronic HCV infection



Progression to cirrhosis


The primary concern for patients with chronic HCV infection is the evolution from chronic hepatitis to advanced fibrosis and cirrhosis. Estimates of progression to cirrhosis have been examined in different populations of HCV-infected patients. In studies involving liver clinic populations, rates of progression to cirrhosis have been estimated at 20%–35% at 20–30 years, which may reflect referral and selection bias. Progression to cirrhosis in community based groups, such as blood donors newly diagnosed with HCV infection, is generally lower, approximately 2%–5% after 10–20 years of infection. In the majority of community-based studies, subjects tend to be younger and a larger proportion will have normal liver function tests, which may be associated with milder disease.


Factors that affect progression to cirrhosis could be related to the virus or to the host. Interestingly, viral factors appear to play the least important role and there are no convincing data to link either HCV genotype or viral load with liver injury, although both of these factors are critical in predicting treatment outcome. Several host factors significantly influence the likelihood of progression to cirrhosis; these include age at infection (cirrhosis occurs more frequently in older compared with younger patients), gender (progression is lower among women than men) and lifetime alcohol intake. Insulin resistance (obesity, diabetes and steatohepatitis) and genetic polymorphisms in inflammatory mediators are likely to be associated with fibrosis progression.

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Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on The hepatitis C-positive patient

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