LONG-TERM CLINICAL FOLLOW-UP OF NON-A, NON-B POSTTRANSFUSIONAL CHRONIC HEPATITIS

Objectives: To study the natural history of non-A, non-B post-transfus ional chronic hepatitis. Design and setting: A prospective study in a university hospital. Patients: The study included 63 patients with non -A, non-B post-transfusional chronic hepatitis who were followed up ov er 106.8 +/- 24.5 months after the acute stage of the disease. Measure ments: We examined the relationship between the clinical and analytica l parameters at baseline, during follow-up and their subsequent evolut ion. Results: Of the patients studied, 56 were seropositive for anti-h epatitis C virus (HCV). During follow-up, liver biochemistry became pe rmanently normal in 13 patients (group I). In 37 patients, high alanin e aminotransferase (ALT) and aspartate aminotransferase (AST) levels w ere maintained with no clinical, biochemical or ultrasound evidence of progression (group II), while 13 patients did show evidence of progre ssion (group III). In the patients from group III, the mean levels of ALT, AST, gamma-glutamyl transpeptidase and gamma-globulin were signif icantly higher than those in group II (P<0.05) and group I (P<0.05) af ter the fourth year of follow-up. The gamma-globulin levels after the fourth year were also significantly higher in group II than in group I (P<0.05). When assessed according to the Knodell index, piecemeal nec rosis and fibrosis in the initial biopsy specimens were significantly greater in group III than in groups I and II (P<0.05) . Conclusions: I n 13 patients from our series, the disease resolved from a biochemical point of view, while in another 13 patients, signs of evolution of th e disease continued during follow-up. There was no difference in the b aseline clinical and biochemical parameters of the patients from the d ifferent groups, although this was not so after the fourth year of fol low-up. Moreover, a greater degree of necrosis and fibrosis was seen i n the initial histological damage in those patients whose disease was seen to progress than in the rest.