PROGNOSIS AND NATURAL-HISTORY OF CHRONIC HEPATITIS-B AND HEPATITIS-C (WARTENBERG-STUDY .1.)

146 patients (62 female, 84 male) with chronic hepatitis B and 80 pati ents (34 female, 46 male) with chronic hepatitis C were regularly exam ined in 1 to 2 year intervals with an average follow-up period of 12 y ears (($) over tilde x). Each time patients were evaluated by physical examination, routine laboratory data, immunological and serological t esting, ultrasonography, and laparoscopy and/or percutaneous liver bio psy. No patient of the study underwent immunosuppressive or antiviral treatment at any time. - The average time data in years are given as t he median value. (($) over tilde x). Chronic hepatitis B: Histologic d iagnoses and their long-term prognosis. Chronic persistent hepatitis ( CPH) on first biopsy: 10% of cases complete recovery after 15 years, 7 0% progression to chronic active hepatitis (CAH) after 5 years; CAH: 3 0% advanced remission/complete recovery 8 years after the first diagno sis of CAH, 40% progression to liver cirrhosis after 5 years; liver ci rrhosis: 50% advanced remission/recovery 4 years after the first diagn osis of cirrhosis, 5% developed a hepatocellular carcinoma (HCC) 11 ye ars after the first diagnosis of cirrhosis. Natural history: In the 11 years following initial diagnosis of HBV-infection spontaneous recove ry was observed in 49% of cases. In 3% of the patients the disease eve ntually caused death (1x hemorrhage of oesophageal varices, 3x HCC aft er 14 to 20 years). Chronic hepatitis C: All patients were anti-HCV- a nd HCV-RNA-positive. - There was no spontaneous elimination of virus i n any patient (maximal follow-up 27 years). - The histologic diagnoses and their long-term prognosis: CPH on first biopsy: 85% of cases show ed no change in liver histology over a 10 year-period (max. follow-up 21 years), 15% developed progression to CAH after 12 years; CAH: 50% d eveloped liver cirrhosis 6 years after the first diagnosis of CAH; liv er cirrhosis: 19% of cases developed HCC after a further 7 years. Natu ral history: In the 12 years following initial diagnosis of HCV-infect ion active CPH developed in 52% of cases, CAH in 24% and active liver cirrhosis in 20%. In 4% of all patients the outcome was fatal (3x HCC after 18 to 26 years). The incidence of clinical complication in the p atients with liver cirrhosis B and C is quoted. - Considering the natu ral history of chronic hepatitis B and C in the Wartenberg-Study, indi cations for interferon treatment are discussed.