ACUTE EXACERBATIONS IN CHRONIC HEPATITIS-C - A CLINICOPATHOLOGICAL AND PROGNOSTIC STUDY

Background/Methods: To examine the incidence, predisposing factors, cl inicopathological characteristics and implications of acute exacerbati ons in chronic hepatitis C, a consecutive series of 194 biopsy-verifie d, anti-HCV-positive and hepatitis B surface antigen-negative patients were followed up and studied for the events of acute exacerbations, s ustained biochemical resolution and development of cirrhosis. Results: During a mean period of 6.2+/-3.5 (1.0-14.0) years, 151 episodes of a cute exacerbations were recorded in 78 patients (40.2%). The estimated annual incidence of acute exacerbations was 11.9%, Fifty-five percent of acute exacerbations were asymptomatic. Histological study of acute exacerbations showed mild to moderate lobular inflammatory activities without bridging hepatic necrosis in all and periportal piecemeal in 23 (42.6%), The clinicopathological features of acute exacerbations in patients with chronic hepatitis C were less severe than those in pati ents with chronic hepatitis B, The route of infection, sex, age, mode of clinical presentation and the initial histology did not influence t he occurrence of acute exacerbations, Only those with alanine aminotra nsferase greater than or equal to 300 U/l at entry tended to develop a cute exacerbations more frequently (p<0.001, odds ratio=3.6, 95% confi dence interval: 1.9-6.5), Acute exacerbations per se did not influence the subsequent development of cirrhosis or sustained biochemical reso lution. Cirrhosis developed more frequently in patients with chronic a ctive hepatitis at entry (p<0.001, odds ratio=6.5, 95% confidence inte rval: 2.6-16.0). Compared with baseline HCV-RNA level, HCV-RNA increas ed in 61% of acute exacerbations but the genotype remained unchanged i n 75%. Conclusions: These results suggest that acute exacerbations als o occur frequently in patients with chronic hepatitis C. They are clin ically indolent, histologically less severe and not likely to be follo wed by sustained remission or development of cirrhosis.