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Slow Rate of Disease Progression in HCV-Positive Women
In a cohort of young women with known dates of infection, rates of long-term progression to fibrosis or cirrhosis were low.
Most data on the natural history of hepatitis C virus (HCV) infection are retrospective and suggest that progression to cirrhosis occurs during 20 to 30 years. In this prospective study, researchers reported 25-year outcomes in a cohort of women in East Germany who acquired HCV infection from a single-source outbreak of contaminated anti-D immunoglobulin in 1978 and 1979.
Researchers reexamined 1980 women from 15 medical centers (70% of the initial cohort). Mean age at infection was 24; 9.7% of women were obese, and 2.6% had diabetes. Only 3% drank more that 40 g of alcohol daily, and 42% did not drink alcohol at all.
After 25 years, 62% of patients complained of constitutional symptoms, such as headaches, myalgias or arthralgias, and fatigue. Overall, 54% had cleared the virus (48% spontaneously and 6% in response to interferon). Only 9 patients (0.5%) had developed overt cirrhosis, 30 patients (1.5%) had developed advanced fibrosis, and 1 patient had developed hepatocellular carcinoma. Of the 10 patients who had died of HCV-related complications, half had comorbidities (e.g., alcohol abuse). The rate of disease progression increased slightly between the 20-year and the 25-year follow-up evaluations: During these last 5 years, six women developed cirrhosis, and nine developed advanced fibrosis.
Comment: In this unique cohort of HCV patients with known dates of infection, the overall rate of disease progression during 20 years was low. However, because the women had few comorbidities and minimal alcohol consumption, the outcomes cannot be generalized to all HCV patients. The rate of progression to cirrhosis increased during the last 5 years of the study.
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology October 25, 2005
Citation(s):
Wiese M et al. Outcome in a hepatitis C (genotype 1b) single source outbreak in Germany — A 25-year multicenter study. J Hepatol 2005 Oct; 43:590-8.
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