Is severe liver disease a common outcome for people with chronic hepatitis C?

For people with chronic hepatitis C, an assessment of their risk of progression to advanced liver disease is a major priority. Early studies of the natural history of chronic hepatitis C suggested that development of cirrhosis was a relatively common outcome, even in the first 20 years of infection. These studies were either cross-sectional liver clinic series of people referred for assessment to specialist clinics, or longitudinal cohorts of people with post-transfusion hepatitis. More recent studies (particularly longitudinal community-based cohorts) indicate that liver disease progression is generally slow, and that a minority of people with chronic hepatitis C will develop advanced liver disease. Based on an extensive review of studies reporting on chronic hepatitis C natural history, we have developed a Markov model of liver disease progression. This model estimates that the risk of progression to cirrhosis is 7% and 20% after 20 and 40 years of infection, respectively. Corresponding estimates for hepatitis C-related mortality are 1% and 4%. However, liver disease progression is highly variable, and certain subgroups of people with chronic hepatitis C are at increased risk of advanced liver disease. Those groups include people with a heavy alcohol intake, those who have coinfection with HIV or HBV, and those who have already progressed to moderate to severe hepatic fibrosis.