Prognosis of chronic hepatitis C: Results of a large, prospective cohort study

The prognosis of chronic hepatitis C virus (HCV) infection is still ill-def ined. The present study prospectively evaluated mortality and complications in a large cohort of patients with chronic hepatitis C, The study included 838 anti-HCV and HCV-RNA-positive patients who were followed for 50.2 +/- 26.9 months (mean +/- SD; range, 6-122 months) in a prospective protocol, D uring follow-up, 62 patients died (31 from Liver disease and 31 from other causes), and 12 patients needed liver transplantation. When compared with a matched general population, hepatitis C increased mortality mainly when ci rrhosis was present and in patients who were less than 50 years old at stud y entry. During follow-up, a further 30 patients developed nonlethal compli cations of cirrhosis. By multivariate regression, survival was decreased by cirrhosis, long disease duration, history of intravenous drug abuse, and e xcessive alcohol consumption, whereas interferon therapy improved survival. Alanine transaminase (ALT), bilirubin, sex, and genotype had no effect on survival. The risk of hepatocellular carcinoma (HCC) (n = 17) was increased by cirrhosis and to a lesser degree by long disease duration and high bili rubin, whereas interferon therapy, genotype, and other factors had no effec t. Chronic hepatitis C is a disease with considerable mortality and morbidi ty when cirrhosis is present at diagnosis. Patients who acquire the infecti on early in life have a markedly increased mortality even when cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major ro le in therapeutic considerations. The present data also suggest that interf eron therapy has a long-term clinical benefit, although it did not reduce t he risk of liver cancer.