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Long-term follow-up of chronic hepatitis non-A, non-B--with special reference to hepatitis C
R Wejstål1, S Hermodsson, G Norkrans
1Department of Infectious Diseases, Ostra Hospital, Sweden.
Insights
This study followed 127 patients with chronic hepatitis C, finding no significant differences in outcomes between anti-HCV positive and negative individuals. Long-term follow-up revealed variable antibody status without impacting disease progression or mortality.
Area of Science:
- Hepatology
- Virology
- Gastroenterology
Background:
- Chronic non-A, non-B hepatitis, now understood as Hepatitis C virus (HCV) infection, represents a significant global health burden.
- Understanding the long-term clinical course and prognostic factors in chronic hepatitis C is crucial for patient management.
- Hepatitis C virus (HCV) infection can lead to chronic liver disease, including chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH).
Purpose of the Study:
- To investigate the long-term outcomes of patients with histologically verified chronic non-A, non-B hepatitis.
- To explore the relationship between hepatitis C virus (HCV) antibody status and disease progression, liver function, and mortality.
- To analyze differences in disease presentation and progression based on risk factors such as blood transfusion and drug addiction.
Main Methods:
- Longitudinal follow-up of 127 patients with chronic non-A, non-B hepatitis for up to 23 years.
- Histological verification of chronic persistent hepatitis (CPH) and chronic active hepatitis (CAH).
- Detection of antibodies to hepatitis C virus (anti-HCV) at baseline and during follow-up; assessment of liver function tests, serial biopsies, and mortality rates.
Main Results:
- 84 patients (66%) had CPH and 43 (34%) had CAH; CPH patients were significantly younger.
- Antibodies to HCV (anti-HCV) were detected in 72% of patients; 28% were anti-HCV negative.
- No significant differences were observed in liver function, disease progression, or mortality between anti-HCV positive and negative groups.
- Five patients seroconverted from anti-HCV positive to negative, with two showing decreased hepatic inflammation.
Conclusions:
- The long-term clinical course and prognosis in chronic hepatitis C appear similar regardless of anti-HCV antibody status.
- Hepatitis C virus (HCV) antibody status may fluctuate during the course of chronic infection.
- Age is a significant factor differentiating chronic persistent hepatitis from chronic active hepatitis.
Abstract:
One hundred and twenty-seven patients with histologically verified chronic non-A, non-B hepatitis were followed for up to 23 years (mean 6.3 years). Thirty-nine were infected by blood transfusion, 58 were drug-addicts and 30 had no obvious source of infection. Chronic persistent hepatitis (CPH) was diagnosed in 84 (66%), while 43 patients (34%) had chronic active hepatitis (CAH) with or without cirrhosis. Patients with CPH were significantly younger (29.7 years vs 46.8 years; p less than 0.01), irrespective of the type of virus exposure. Antibodies to hepatitis C virus (anti-HCV) were detectable in 91 patients (72%) and 36 (28%) were anti-HCV negative. Fifteen patients with acute onset, and negative for anti-HCV at the start, became positive during follow-up; 12 of them within 4.5 months. We found no differences among anti-HCV positive and anti-HCV negative patients in liver function tests, resolving rate, morphological progression in serial biopsies or mortality rate. Five previously anti-HCV positive patients became negative during follow-up and in two of them this was accompanied by decreasing hepatic inflammation.