LACK OF CORRELATION BETWEEN HEPATITIS-C VIRUS GENOTYPES AND CLINICAL COURSE OF HEPATITIS-C VIRUS-RELATED CIRRHOSIS

The influence of the hepatitis C virus (HCV)-genotype on liver disease severity was evaluated in 429 consecutive patients with chronic hepat itis C, including 109 with cirrhosis who were followed up prospectivel y, allowing for the assessment of the role of the HCV-genotype on dise ase outcome and on the development of hepatocellular carcinoma (HCC). HCV-1 was detected in 147 (46%) patients without cirrhosis and in 47 ( 43%) with cirrhosis (P: not significant), being mainly HCV-1b. HCV-2 w as found in 103 (32%) cases without cirrhosis and in 30 (27.5) with ci rrhosis (P: not significant), being mainly HCV-2a. HCV-3 was detected in 32 (10%) patients without cirrhosis and in 2 (2%) with cirrhosis (P < 0.005). Infection with more than one genotype (HCV-1/HCV-2 and HCV- 1/HCV-3) was observed only in cirrhotic patients (6 of 109; 5.5%). Dur ing a mean follow-up of 67 +/- 22 months, 21 (19%) patients with cirrh osis showed worsening in Child's stage, 5 (4.5%) underwent liver trans plantation, 23 (21%) developed HCC, and 24 (22%) died of complication of Liver disease; the overall incidence of at least one of these event s was 38.5%. By the Kaplan-Meier method and log-rank test, the cumulat ive probability of developing each or at least one of the above events did not differ in relation to the genotype of infecting HCV, apart fr om patients with mixed genotype infection who showed a significantly h igher incidence of death (P <.05). These data indicate that HCV-genoty pes do not have a significant effect on the severity and outcome of li ver disease in patients with chronic HCV-infection. Patients with cirr hosis who are also infected by HCV-1 and HCV-2 had a similar prognosis and progression to HCC, while patients infected by more than one geno type showed the most unfavorable course of disease.