LONG-TERM OUTCOME OF CHRONIC HEPATITIS-C INFECTION IN A LOW-PREVALENCE AREA

Background: Although hepatitis C virus (HCV) infection is recognized a s an important causative factor in the development of liver cirrhosis and hepatocellular cancer (HCC), the strength of this correlation has been difficult to confirm in low-prevalence areas. Methods. Stored ser um samples from 987 consecutive (1978-88) patients with chronic liver disease were tested with an enzyme-linked immunosorbent assay for anti -HCV and further confirmed by immunoblot. To evaluate the long-term ou tcome, the cohort was followed up until 1995, for a median observation time of 10 years. Results: Anti-HCV, confirmed by immunoblot was foun d in 9.5% (94 of 987) of the patients, and at inclusion most patients were asymptomatic irrespective of anti-HCV status. Of the 445 patients a ho died during the study period. 44 were HCV-positive. A liver-rela ted cause of death was far commoner and the age-adjusted survival shor ter among HCV-positive patients than among HCV-negative ones. At death 68% (30 of 44) of the HCV-positive subgroup had developed cirrhosis, and 30% (13 of 44) had concurrent HCC, as compared with 36% (142 of 39 3) (P=0.001) and 8% (31 of 393) (P=0.001), respectively, of the HCV-ne gative subgroup. HCV infection (P < 0.001), alcohol abuse (P < 0.001), and immigrant status (P = 0.045) were independent factors with regard to the development of cirrhosis, whereas HCV infection (P = 0.040) an d immigrant status (P = 0.012) were independent factors with regard to HCC. Conclusions: HCV infection is common among patients with chronic liver disease, even when clinical evidence of viral infection is spar se, and constitutes a significant cause of death e, en in a low-preval ence area.