Progression to Cirrhosis in Hepatitis C Patients: An Age-dependent Process

Pierre Pradat; Nicolas Voirin; Hans Ludger Tillmann; Michèle Chevallier; Christian Trépo

Disclosures

Liver International. 2007;27(3):335-339. 

In This Article

Abstract and Introduction

Background: Age at infection is known to be associated with disease progression rate in hepatitis C virus (HCV) infected patients. The aim of this study was to assess when cirrhosis is expected to occur according to host and viral factors.
Methods: Fibrosis progression was studied in 247 naive HCV patients using multiple regression analysis. The expected age at cirrhosis was calculated for each patient.
Results: Progression rate was 0.13, 0.14, 0.27, and 0.36 U of fibrosis/year for patients with age at infection ≤19, 20–24, 25–36 and ≥37 years, respectively. Age at infection above 37 years was independently associated with fast progression (rate>0.13; P=0.001). Body mass index >25 kg/m2 and alanine aminotransferase>3 × ULN are also possibly associated with faster progression. Based on progression rates, the expected age at cirrhosis is 65.4, 64.6, 64.8 and 69.4 years for age at infection ≤19, 20–24, 25–36, ≥37 years, respectively.
Conclusion: Most HCV patients, if untreated, are expected to develop cirrhosis at about 65 years, irrespective of the age at infection. Thus, age itself seems even more important than age at infection for predicting the occurrence of liver cirrhosis. A specific active monitoring and therapeutic approach should be adopted in older patients to prevent progression to cirrhosis and its complications.

Hepatitis C virus (HCV) infection has been identified as the main reason for end stage liver disease, approaching 50% of liver transplantations performed in the US.[1] Although several prospective studies have reported low rates of liver complications[2–6] after HCV infection, it is generally agreed that progression of liver disease in 20–30% of patients can lead to compensated and eventually decompensated cirrhosis or hepatocellular carcinoma or both.[7,8] However, two main issues remain to be clarified. Once a patient with HCV infection has been identified, the first question is to know whether this patient will progress to liver complications, mainly cirrhosis. If yes, the second issue is to know how fast he will progress taking into account identified factors possibly associated with the rate of progression.

Based on the assessment of the rate of fibrosis progression, the aim of the present study was to determine when cirrhosis is expected to occur with regard to host and viral factors.

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