A CLINICOPATHOLOGICAL STUDY OF CHRONIC NON-A, NON-B (TYPE-C) HEPATITIS IN TAIWAN - COMPARISON BETWEEN POSTTRANSFUSION AND SPORADIC PATIENTS

To elucidate the clinicopathological course and the role of hepatitis C virus in posttransfusion and sporadic chronic non-A, non-B hepatitis in Taiwan, we retrospectively studied 85 histologically confirmed pat ients with long-term follow up. Antibodies against hepatitis C virus ( anti-HCV) by a second-generation assay were positive in 81% of the pat ients: 88% in the posttransfusion group and 76% in the sporadic group. Clinical manifestations were generally mild, and were noted in only h alf of the patients. During follow up, 33% (28 of 85 patients) had epi sodes of acute exacerbation of chronic liver disease and 24% (20 of 85 ) had normalized liver tests. Patients with normalized liver tests wer e usually anti-HCV negative (55% vs. 8%, p<0.001). In 34 patients who had had blood transfusions, initial liver biopsies revealed chronic ac tive hepatitis in 41%, active cirrhosis in 6%, and inactive cirrhosis in 9%. Follow-up biopsies in eight patients in this group showed histo logical progression in three after an average of 40.6 months. In the 5 1 sporadically infected patients, initial work-up revealed chronic act ive hepatitis in 37%, active cirrhosis in 4%, and inactive cirrhosis i n 14%. Among the nine who underwent repeated biopsies, only one (11%) had progression. Patients above age 40 displayed more severe histologi c activity than those below 40 (p<0.005). Three patients, all with cir rhosis, died of hepatocellular carcinoma 7 to 12 years after follow up . Further genotyping study of hepatitis C virus in 28 patients showed that type II virus was most predominant in Taiwan and histologic sever ity was similar among patients infected with different genotypes. We c onclude that hepatitis C virus is the major cause of chronic non-A, no n-B hepatitis in Taiwan, regardless of the routes of transmission. Thi s chronic hepatitis is clinically stable and slowly progressive. A sig nificant proportion of the patients will evolve to cirrhosis, and even tually hepatocellular carcinoma. (C) Journal of Hepatology.