Histological progression during short-term follow-up of patients with chronic hepatitis C virus infection

Assessment of prognosis from hepatitis requires liver histology. When the f ibrosis stage is known, and if the fibrosis progression rate can be establi shed, time to development of cirrhosis can be calculated. The fibrosis prog ression rate can be calculated from a single biopsy when duration of infect ion prior to biopsy is known. Sequential biopsies can also be examined. In this work, we studied histological activity and fibrosis stage in liver bio psies of 157 hepatitis C virus (HCV)-infected patients, including 92 for wh om the approximate duration of infection was known. The mean fibrosis progr ession rate was 0.09 units per year, and was not influenced by mode of infe ction or viral genotype. Forty-six patients who had very mild histological changes in the initial biopsy underwent repeat biopsy 2 years later (with n o intervening anti-viral treatment). Comparison of paired biopsies confirme d a tendency to histological progression and increasing hepatic fibrosis (m ean, 0.15 fibrosis units per year). A normal baseline alanine aminotransfer ase (ALT) value was associated with slow fibrosis progression before baseli ne biopsy and between biopsies. These data do not differ from published cro ss-sectional and longitudinal studies, and suggest that histological progre ssion will be observed during follow-up of most patients, including those w ith mild histological changes at time of initial assessment.