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Age at infection affects the long-term outcome of transfusion-associated chronic hepatitis C
Eliseo Minola1, Daniele Prati, Fredy Suter
1Infectious Diseases Unit, Ospedali Riuniti, Bergamo, Italy.
Insights
Hepatitis C virus (HCV) infection from transfusions can lead to cirrhosis, especially when acquired at older ages. Early, aggressive treatment is recommended for older patients to prevent advanced liver disease.
Area of Science:
- Hepatology
- Virology
- Transfusion Medicine
Background:
- Hepatitis C virus (HCV) transfusion-associated infections posed a significant risk before donor screening.
- Chronic HCV infection can progress to cirrhosis, a serious liver condition.
Purpose of the Study:
- To determine the frequency and progression rate of cirrhosis in transfusion-associated chronic HCV.
- To identify prognostic factors for cirrhosis development in these patients.
Main Methods:
- Retrospective analysis of 268 patients with transfusion-associated HCV infection and liver disease.
- Ultrasound-guided liver biopsy and multivariate analysis of clinical data.
- Long-term follow-up (mean 18.4 years) to assess cirrhosis development.
Main Results:
- 20.1% of patients developed cirrhosis after a mean follow-up of 18.4 years.
- Cirrhosis risk was independently associated with follow-up duration, age at infection/biopsy, and ALT levels.
- Older age at infection significantly increased the risk and shortened the time to cirrhosis development.
Conclusions:
- Age at HCV infection and disease activity are key factors in cirrhosis progression.
- Aggressive treatment is advised for older individuals infected with HCV to prevent end-stage liver disease.
Abstract:
Before the introduction of hepatitis C virus (HCV) screening for blood donors, the risk of acquiring HCV infection as a result of a transfusion was about 10%. The aim of this study was to assess the frequency and rate of progression to cirrhosis in patients with transfusion-associated chronic HCV infection and identify possibly negative prognostic factors. Of 2477 consecutive patients with clinical or laboratory evidence of liver disease, 392 (16%) were anti-HCV- and HCV-RNA-positive, had anamnestic evidence of a single and precisely dated transfusion event, and showed no other causes of chronic liver disease; 268 (68%) underwent ultrasound-guided liver biopsy and were enrolled in the study. After a mean interval of 18.4 years, 54 patients (20.1%) had cirrhosis, which multivariate analysis showed to be independently associated with the duration of follow-up, age at infection and at the time of liver biopsy, and serum alanine aminotransferase levels at biopsy. The time necessary to have a 50% probability of developing cirrhosis in patients aged 21-30, 31-40, and more than 40 years was 33, 23, and 16 years, respectively. In comparison with those aged 20 years or less at infection, the risk ratio of developing cirrhosis over a period of 30 years for patients aged 21-30 and at least 31 years at infection was, respectively, 4.51 (95% confidence interval, 1.03-19.76) and 12.29 (95% confidence interval, 3.06-49.40). In patients with transfusion-associated chronic hepatitis C, the risk of cirrhosis is related to age at infection and disease activity. Our findings suggest that an aggressive therapeutic approach should be adopted in patients infected by HCV at an older age to prevent the progression to end-stage liver disease.