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A comparison of fibrosis progression in chronic liver diseases
Thierry Poynard1, Philippe Mathurin, Ching-Lung Lai
1Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, et UPRESA 8067 CNRS, 47-83 Boulevard de l'Hopital, 75651 Paris Cedex 13, France. tpoynard@teaser.fr
Background/Aims:
No study has compared the liver fibrosis progression rates among chronic liver diseases and the risk factors in order to better organize screening strategies.
Methods:
A total of 4852 patients were retrospectively studied (chronic hepatitis C (HCV) [n=2313], human immunodeficiency virus (HIV)-HCV co-infection (HIV-HCV [n=180]), hepatitis B (HBV [n=777]), alcoholic liver disease (ALD [n=701]), primary biliary cirrhosis (PBC [n=406]), genetic hemochromatosis (GH [n=383]) auto-immune hepatitis (AIH [n=57]) and delta hepatitis (n=35). The fibrosis progression rates were estimated from birth and from the date of exposure, when known, to the first biopsy.
Results:
There were highly significant differences in the rates of fibrosis progression, the most rapid being HIV-HCV co-infection (50% cirrhosis percentile at 52 years of age) and the slowest being PBC (50% cirrhosis percentile at 81 years). There was an acceleration of fibrosis progression with aging. Fibrosis progression was slower in females compared with males for HCV, HBV, GH, and PBC. In contrast, in ALD, the fibrosis progression was more rapid in females.
Conclusions:
Rates of fibrosis progression differ markedly between the predominant causes of chronic liver disease, and according to age and gender. Patients with HIV-HCV co-infection are at particularly high risk of fibrosis progression.