HISTOLOGICAL EVOLUTION OF CHRONIC HEPATITIS-C - FACTORS RELATED TO PROGRESSION

We have evaluated the histological progression of liver disease in 29 untreated patients with chronic hepatitis C. All patients were positiv e to antibodies to hepatitis C virus by ELISA2 and RIBA2. Two liver bi opsies were carried out for each patient, with an interval ranging bet ween 12 and 126 months (mean 50.2+/-30.7). In all cases the usual hist ological classification was applied and the histological activity inde x scoring system according to Knodell et al. was determined. Fifteen c ases worsened (51.7%), 12 cases showed no histological changes (41.4%) and two patients improved (6.9%). Cirrhosis was found in five patient s (18.5%) in the second liver biopsy. Epidemiological, clinical, bioch emical and histological parameters were compared between the group wit hout histological progression and the group with impairment in liver h istology. Factors related to histological worsening were: more advance d age (p=0.002), high levels of aspartate aminotransferase (p=0.04), h igh global histological activity index (p=0.03) and piecemeal necrosis and bridging necrosis scores (p=0.02) at first biopsy. The histologic al activity index can be applied to assess the natural history of chro nic viral hepatitis, and is a good tool to evaluate the prognosis. Thu s chronic hepatitis C virus infection is a histologically progressive disease in at least half the cases.