FACTORS ASSOCIATED WITH CIRRHOSIS DEVELOPMENT IN CHRONIC HEPATITIS-C PATIENTS FROM AN AREA OF LOW-PREVALENCE

The aim of this study was to evaluate the importance of different endo genous and exogenous factors associated with cirrhosis development amo ng heptatitis C virus (HCV)-positive individuals from an area of low p revalence. We studied 106 consecutive HCV RNA positive patients who ha d undergone liver biopsy. Each patient was assessed with special atten tion to risk factors for hepatitis C infection, average daily alcohol consumption and analysis of plasma levels of alpha(1)-antitrypsin (alp ha(1)AT) and alpha(1)-antichymotrypsin (alpha(1)ACT), Viral RNA, ampli fied from serum with the polymerase chain reaction (PCR) technique, wa s used for genotyping, Liver biopsies were assessed according to conve ntional histopathological criteria, and for necroinflammatory activity (grade) and fibrosis (stage) according to a numerical scoring system. The presence of cirrhosis (stage 4) was used as the dependent variabl e in multivariate logistic regression analysis. Alcohol abuse (P = 0.0 07), age at entry (P < 0.001), immigrant status (P = 0.017) and a low alpha(1)ACT level (P = 0.008) were all independent determinants of pro gression to cirrhosis whereas HCV genotype 1, estimated duration of HC V infection and positivity for antibodies to hepatitis B core antigen (HBcAb) were not. Cirrhosis occurred at a significantly younger age (P = 0.005) among alcohol abusers, Hence, both endogenous and exogenous factors such as subnormal alpha(1)ACT levels and alcohol appear to con tribute to the rate of progression to cirrhosis among HCV-positive pat ients.