EPIDEMIOLOGIC RISK-FACTORS AND CLINICOPATHOLOGICAL PRESENTATION IN CHRONIC HEPATITIS

BACKGROUND/AIMS: To analyze the epidemiological risk factors related t o clinical and pathological patterns on presentation in patients with chronic hepatitis C (CHC) without cirrhosis. METHODOLOGY: This prospec tive study, carried out in the Liver Unit of the Princesa University H ospital, includes a population of 253 patients with CHC without clinic al features of cirrhosis evaluated for clinical, virological and histo logical assessment. A standardized questionnaire was used to identify the presence of risk factors for hepatitis C virus (HCV) infection. An ti-HCV was tested by ELISA-S and RIBA-S assays. HCV RNA was analyzed b y nested PCR. Liver biopsies were obtained percutaneously or in some c ases by laparoscopy. RESULTS: The mean age of patients was 43+/-15 yea rs and 154 were males, being significantly younger than females (39+/- 13 versus 50+/-14 years). A source of infection was ascertained in 204 (80.6%) patients and only 37 (14.6%) referred a history of acute hepa titis. Anti-HCV was ELISA-2 positive in all 253, and 133 were tested b y RIBA-2 (131 positive, 1 negative, I indeterminate) and by nested PCR to detect HCV RNA, with positivity in all except 3, including both th e RIBA-2 negative and indeterminate. No differences appeared in the hi stological activity index according to routes of infection, but in com paring sexes, females had a significantly higher total score as well a s the inflammatory/hepatitic index and fibrosis. CONCLUSIONS: In CHC n o epidemiological, clinical or biochemical patterns are indicative of pathological features. The more severe disease in females could be att ributed to the fact that they were older and it could be assumed that viral infection progressed longer. This slow progression calls for a t herapeutical option over many years.