Natural history of initially mild chronic hepatitis C

[Guest guest]

Digestive and Liver Disease

Volume 36, Issue 10 , October 2004, Pages 646-654

doi:10.1016/j.dld.2004.06.011

Copyright © 2004 Editrice Gastroenterologica Italiana S.r.l. Published by

Elsevier Ltd.

Clinical Review

Natural history of initially mild chronic hepatitis C

A. Alberti, , a, b, L. Benvegnùa, S. Boccatoa, A. Ferraria and G.

Sebastiania

a Department of Clinical and Experimental Medicine, University of Padova,

Via Giustiniani, 2, 35128, Padua, Italy

b Venetian Institute of Molecular Medicine, Padua, Italy

Available online 4 August 2004.

Abstract

The hepatitis C virus is a leading cause of chronic liver disease, cirrhosis

and hepatocellular carcinoma in western countries. Chronic hepatitis C is

highly heterogeneous and many patients present with a mild form of liver

disease. Population-based studies have indeed demonstrated that around 50%

of hepatitis C virus carriers have persistently normal ALT and two-third

have mild histological liver lesions. Studies on the natural history of

initially mild chronic disease indicate that the short-term outcome is

always benign. However, progression of liver fibrosis can be observed at

long-term (>5-7 years) follow-up, particularly in those cases who have

elevated and/or fluctuating transaminase levels. Observational prospective

studies and outcome modelling projections indicate that the risk of liver

disease progression towards severe fibrosis/cirrhosis is minimal at 10-15

years in hepatitis C virus carriers with persistently normal ALT, around

5-10% in patients with elevated ALT and F0 (no fibrosis) in the initial

biopsy but >30-40% in chronic carriers with elevated ALT and F1 (portal

fibrosis) in the initial biopsy. Cofactors like age at infection, alcohol,

coinfections and liver steatosis accelerate disease progression. On the

basis of these findings, patients with initially mild chronic hepatitis C

and elevated ALT should be proposed for antiviral therapy in the absence of

contraindications.

Author Keywords: Hepatitis C; HCV; Natural history

Corresponding author. Tel.: +39 049 821 2294; fax: +39 049 821 1826.

[Guest guest]

Digestive and Liver Disease

Volume 36, Issue 10 , October 2004, Pages 646-654

doi:10.1016/j.dld.2004.06.011

Copyright © 2004 Editrice Gastroenterologica Italiana S.r.l. Published by

Elsevier Ltd.

Clinical Review

Natural history of initially mild chronic hepatitis C

A. Alberti, , a, b, L. Benvegnùa, S. Boccatoa, A. Ferraria and G.

Sebastiania

a Department of Clinical and Experimental Medicine, University of Padova,

Via Giustiniani, 2, 35128, Padua, Italy

b Venetian Institute of Molecular Medicine, Padua, Italy

Available online 4 August 2004.

Abstract

The hepatitis C virus is a leading cause of chronic liver disease, cirrhosis

and hepatocellular carcinoma in western countries. Chronic hepatitis C is

highly heterogeneous and many patients present with a mild form of liver

disease. Population-based studies have indeed demonstrated that around 50%

of hepatitis C virus carriers have persistently normal ALT and two-third

have mild histological liver lesions. Studies on the natural history of

initially mild chronic disease indicate that the short-term outcome is

always benign. However, progression of liver fibrosis can be observed at

long-term (>5-7 years) follow-up, particularly in those cases who have

elevated and/or fluctuating transaminase levels. Observational prospective

studies and outcome modelling projections indicate that the risk of liver

disease progression towards severe fibrosis/cirrhosis is minimal at 10-15

years in hepatitis C virus carriers with persistently normal ALT, around

5-10% in patients with elevated ALT and F0 (no fibrosis) in the initial

biopsy but >30-40% in chronic carriers with elevated ALT and F1 (portal

fibrosis) in the initial biopsy. Cofactors like age at infection, alcohol,

coinfections and liver steatosis accelerate disease progression. On the

basis of these findings, patients with initially mild chronic hepatitis C

and elevated ALT should be proposed for antiviral therapy in the absence of

contraindications.

Author Keywords: Hepatitis C; HCV; Natural history

Corresponding author. Tel.: +39 049 821 2294; fax: +39 049 821 1826.

[Guest guest]

Digestive and Liver Disease

Volume 36, Issue 10 , October 2004, Pages 646-654

doi:10.1016/j.dld.2004.06.011

Copyright © 2004 Editrice Gastroenterologica Italiana S.r.l. Published by

Elsevier Ltd.

Clinical Review

Natural history of initially mild chronic hepatitis C

A. Alberti, , a, b, L. Benvegnùa, S. Boccatoa, A. Ferraria and G.

Sebastiania

a Department of Clinical and Experimental Medicine, University of Padova,

Via Giustiniani, 2, 35128, Padua, Italy

b Venetian Institute of Molecular Medicine, Padua, Italy

Available online 4 August 2004.

Abstract

The hepatitis C virus is a leading cause of chronic liver disease, cirrhosis

and hepatocellular carcinoma in western countries. Chronic hepatitis C is

highly heterogeneous and many patients present with a mild form of liver

disease. Population-based studies have indeed demonstrated that around 50%

of hepatitis C virus carriers have persistently normal ALT and two-third

have mild histological liver lesions. Studies on the natural history of

initially mild chronic disease indicate that the short-term outcome is

always benign. However, progression of liver fibrosis can be observed at

long-term (>5-7 years) follow-up, particularly in those cases who have

elevated and/or fluctuating transaminase levels. Observational prospective

studies and outcome modelling projections indicate that the risk of liver

disease progression towards severe fibrosis/cirrhosis is minimal at 10-15

years in hepatitis C virus carriers with persistently normal ALT, around

5-10% in patients with elevated ALT and F0 (no fibrosis) in the initial

biopsy but >30-40% in chronic carriers with elevated ALT and F1 (portal

fibrosis) in the initial biopsy. Cofactors like age at infection, alcohol,

coinfections and liver steatosis accelerate disease progression. On the

basis of these findings, patients with initially mild chronic hepatitis C

and elevated ALT should be proposed for antiviral therapy in the absence of

contraindications.

Author Keywords: Hepatitis C; HCV; Natural history

Corresponding author. Tel.: +39 049 821 2294; fax: +39 049 821 1826.

[Guest guest]

Digestive and Liver Disease

Volume 36, Issue 10 , October 2004, Pages 646-654

doi:10.1016/j.dld.2004.06.011

Copyright © 2004 Editrice Gastroenterologica Italiana S.r.l. Published by

Elsevier Ltd.

Clinical Review

Natural history of initially mild chronic hepatitis C

A. Alberti, , a, b, L. Benvegnùa, S. Boccatoa, A. Ferraria and G.

Sebastiania

a Department of Clinical and Experimental Medicine, University of Padova,

Via Giustiniani, 2, 35128, Padua, Italy

b Venetian Institute of Molecular Medicine, Padua, Italy

Available online 4 August 2004.

Abstract

The hepatitis C virus is a leading cause of chronic liver disease, cirrhosis

and hepatocellular carcinoma in western countries. Chronic hepatitis C is

highly heterogeneous and many patients present with a mild form of liver

disease. Population-based studies have indeed demonstrated that around 50%

of hepatitis C virus carriers have persistently normal ALT and two-third

have mild histological liver lesions. Studies on the natural history of

initially mild chronic disease indicate that the short-term outcome is

always benign. However, progression of liver fibrosis can be observed at

long-term (>5-7 years) follow-up, particularly in those cases who have

elevated and/or fluctuating transaminase levels. Observational prospective

studies and outcome modelling projections indicate that the risk of liver

disease progression towards severe fibrosis/cirrhosis is minimal at 10-15

years in hepatitis C virus carriers with persistently normal ALT, around

5-10% in patients with elevated ALT and F0 (no fibrosis) in the initial

biopsy but >30-40% in chronic carriers with elevated ALT and F1 (portal

fibrosis) in the initial biopsy. Cofactors like age at infection, alcohol,

coinfections and liver steatosis accelerate disease progression. On the

basis of these findings, patients with initially mild chronic hepatitis C

and elevated ALT should be proposed for antiviral therapy in the absence of

contraindications.

Author Keywords: Hepatitis C; HCV; Natural history

Corresponding author. Tel.: +39 049 821 2294; fax: +39 049 821 1826.