THE LONG-TERM PATHOLOGICAL EVOLUTION OF CHRONIC HEPATITIS-C

Most patients infected with hepatitis C virus (HCV) develop chronic he patitis. Unfortunately, the pathological evolution of this disease ove r time is not completely understood. We studied 70 HCV-positive patien ts, from whom 2 to 10 liver biopsy specimens (mean, 3.9) had been obta ined during an interval of 1 to 26 years (mean, 8.8 years). Each biops y specimen was evaluated-independently by four pathologists who each p rovided a numerical score for the grade of portal/periportal necroinfl ammation (0-4), grade of lobular necroinflammation (0-4), their sum (f inal grade), and the stage of fibrosis (1-4), The scores were correlat ed with progression of disease, if any, and transition to cirrhosis. D uring follow-up, 35 patients (50%) developed cirrhosis. Cirrhosis deve loped in all patients with a high final grade (greater than or equal t o 5) of necroinflammation on initial biopsy who were followed for 10 y ears and in 96% of patients with an intermediate final grade (3.5-4.9) who were followed for 17 years. Only 30.4% of patients with low final grade (less than or equal to 3.4) on initial biopsy developed cirrhos is after 13 years. All patients with evidence of septal fibrosis with incomplete nodularity (stage 3.0-3.4) in the initial biopsy progressed to unequivocal cirrhosis by 10 years. The rate of progression to cirr hosis was accelerated in patients whose initial biopsies showed high-g rade and -stage lesions, This study demonstrates the importance of gra ding and staging liver biopsy lesions in chronic hepatitis C, particul arly for patients with high-grade necroinflammation, septal fibrosis, and regions of nodularity on initial biopsy who are at high risk of de veloping advanced cirrhosis in the ensuing decade.