Mild hepatitis C infection will rapidly worsen in one in three of those affected, suggests new research published in the medical journal Gut. This is particularly likely in those who are older when first infected, and those who already have a degree of inflammation and fibrosis in their liver at diagnosis.

The viral liver infection hepatitis C (HCV) is mainly passed on through injecting drug use and blood transfusions before 1991, when the screening of blood products for the virus was introduced. HCV is an important cause of chronic liver disease, eventually leading to liver cancer. But treatment with interferon is complicated and expensive, and only works in around one in two of those treated.

The authors base their conclusions on 214 patients with HCV whose average age was 36; 126 of them were men and their liver disease was mostly mild. None of the patients was given any treatment, and they were monitored by tissue sampling of their liver every 2.5 years.

One in two of the patients admitted to having used intravenous drugs in the past; almost one in four had been transfused with infected blood products.

At the first biopsy, the average fibrosis score (Ishak score) was 3. Most patients had scores of 6 or less; scores of up to 6 are considered to denote mild disease. Within 30 months, when the next tissue sample was taken, the Ishak score had increased by one or more points in a third (70) of the patients, and by two or more points in one in 10 of them.

The factors influencing progression of the disease were older age at infection, rather than the length of infection, and degree of inflammation and scarring at the first biopsy.

Unlike the results of previous research, gender, alcohol consumption, virus type and other indicators of poor liver function did not seem to have any effect on the rate of progression, although the authors point out that it is important to reduce alcohol consumption once infected.

The authors conclude that even mild HCV is a progressive disease, and those patients affected are likely to require a considerable degree of health care as they age over the next 20 years.

From Gut
Thank you HCV Advocate