[Clinical forms and prognosis of hepatitis C]

Hepatitis C virus infects around 600,000 French people, mainly after parenteral exposure (in association with transfusion before 1990 and with intravenous drug use). Spontaneous resolution at the acute stage of the infection occurs in around 30% of cases while chronic infection is observed in around 70% of cases and its main risk is evolution to cirrhosis. Three predictive factors of cirrhosis have been identified: the duration of infection (greater than 20 years), the age at contamination (greater than 40 years) and a chronic alcohol consumption (> 80 g/day). Immunosuppressive situations (drug-related immune suppression for the prevention of graft rejection in allograft recipients or human immune deficiency virus-coinfection) as well as hepatitis B virus coinfection enhance the risk of cirrhosis and reduce the time of occurrence of cirrhosis. These predictors have to be considered in the information to the patients and in therapeutic decisions. They explain that any hepatitis C virus-infected patient has to undergo a liver biopsy to evaluate the necro-inflammatory activity and the fibrosis of the liver disease to delineate the place of a follow-up with a control of aggravation factors (alcohol discontinuation) and of an antiviral therapy.