William F. Balistreri, MD


December 27, 2013

In This Article

Outcomes of Chronic HCV Infection

Natural history. The German HCV-contaminated anti-D cohort provides an ideal population to investigate the natural course of HCV infection in a large and homogenous cohort of young women followed from the date of HCV inoculation. Previous follow-up studies at 20 years and 25 years after infection suggested slow rates of fibrosis progression in this unique cohort. A prospective community-based multicenter study[10] reevaluated liver disease progression in 718 patients from the original anti-D cohort at 35 years after infection.

Patients with self-limited HCV infection were compared with those who did not eliminate the virus. In the overall cohort, 9% of patients showed clinical signs of cirrhosis at 35 years after infection. The women with self-limited HCV infection or SVR after antiviral treatment were protected from progressive liver disease and showed the best long-term clinical outcomes. Liver disease progression largely depended on HCV infection status.

This study provides further evidence for a mild but significant disease progression at 35 years after infection in the German HCV-contaminated anti-D cohort.

Benefits of HCV eradication. For patients with chronic HCV infection, achieving an undetectable viral load reduces the risk for death by 45% and the risk for liver-related adverse events by 27%. McCombs and colleagues[11,12] documented the impact of viral load suppression and treatment on morbidity and mortality in patients with HCV infection receiving care through the US Veterans Health Administration.

They identified and examined the clinical records of 128,769 patients who were enrolled in the database in 1999-2010. Only 24% of patients initiated treatment, and among those treated patients, only 16% achieved an undetectable viral load at some point after starting treatment.


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