[The progression of hepatic fibrosis in chronic hepatitis C]

The natural history of liver fibrosis in 47 untreated patients with chronic hepatitis C and no cirrhosis, as well as the factors associated with its progression, were evaluated by examining two consecutive liver biopsies, separated by an average interval of 64.8 +/- 62.9 months (12-244). In all the biopsies, the degree of necroinflammation and the stage of fibrosis were determined on a scale from 0+ to 4+. In 53% of the patients, liver fibrosis did not progress. The interval between biopsies was significantly higher in those who progressed from one stage to another (85 +/- 77 months) than in those who did not (41 +/- 27 months), p = 0.014. Two factors were independently associated with a greater risk of fibrosis progression: a history of daily alcohol intake > or = 80 g (p = 0.02) and having acquired an infection through a known parenteral mechanism such as blood transfusion, major surgery or hemodialysis (p = 0.018). Necroinflammation was significantly diminished in the second biopsy due to a lesser necrosis and inflammation of the lobules.

a) liver fibrosis progression is independent of necroinflammation; b) progression is related to the duration of the disease and with the mechanism of transmission, and c) it is aggravated by excessive alcohol consumption.