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Natural history of acute hepatitis C
1Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan. etanaka@hsp.md.shinshu-u.ac.jp
Insights
Approximately 70% of patients with acute hepatitis C develop chronic infection. Liver fibrosis progresses over decades, particularly in older individuals, highlighting the long-term impact of hepatitis C virus (HCV) infection.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Acute hepatitis C virus (HCV) infection can lead to chronic disease.
- Long-term outcomes and progression of liver damage are critical concerns.
Purpose of the Study:
- To investigate the short- and long-term clinical outcomes of acute hepatitis C.
- To analyze the progression of liver fibrosis and associated factors in HCV-infected patients.
Main Methods:
- Prospective study of patients with acute hepatitis C.
- Monitoring of HCV viraemia and alanine aminotransferase (ALT) normalization.
- Analysis of liver histology via repeated biopsies and assessment of fibrosis staging.
- Evaluation of the time between blood transfusion and hepatocellular carcinoma (HCC) diagnosis.
Main Results:
- 69% of patients with acute hepatitis C developed chronic infection at 12 months.
- Alanine aminotransferase normalization was significantly lower in chronic HCV patients (5%) compared to resolved cases (100%).
- Liver fibrosis progressed over decades (mean score 0.9 to 3.5), with faster progression in patients over 50.
- Hepatocellular carcinoma diagnosis occurred sooner after blood transfusion in younger recipients.
Conclusions:
- The majority of acute hepatitis C cases progress to chronic infection.
- Chronic hepatitis C leads to gradual liver fibrosis over decades, accelerated by age.
- Age at blood transfusion influences the latency period to hepatocellular carcinoma diagnosis.
Abstract:
To study the short- and long-term outcomes of acute hepatitis C, three groups of patients were enrolled. Of 26 patients with acute hepatitis C, 18 (69%) maintained HCV viraemia and 8 had cleared virus naturally at 12 months after the onset. Normalization of ALT was seen in all 8 patients with acute resolving hepatitis, but in only 1 (5%) of the 18 patients with chronic HCV infection (P< 0.001). Changes in liver histology were analysed in 43 patients with acute hepatitis C who underwent repeated liver biopsy. The mean score of the fibrotic stage was 0.9 within 1 year of the onset, and it increased gradually up to 3.5 at 30 years from the onset (0.1 grade/year). The fibrotic stage increased more rapidly in patients aged more than 50 years. In 115 patients, the mean duration between blood transfusion and the diagnosis of HCC increased significantly (P< 0.001) in accordance with increasing age at blood transfusion; 35 +/- 5.3 years in patients aged less than 30 years, 30 +/- 4.9 years in those aged between 30 and 40 years, and 25 +/- 6.8 years in those aged more than 40 years. In conclusion, approximately 70% of patients with acute hepatitis C develop chronic hepatitis. Once patients develop chronic hepatitic fibrosis of the liver, it progresses over several decades, faster in older patients.