Assessment of long-term outcomes of community-acquired hepatitis C infection in a cohort with sera stored from 1971 to 1975

The aim of this study was to examine the long-term effects of hepatitis C v irus (HCV) infection on a cohort of patients admitted with acute viral hepa titis from 1971 through 1975. The availability of stored sera from this tim e enabled testing to identify those who were anti-HCV-positive on admission . Sixteen percent (n = 238) of the cohort tested anti-HCV-positive. The une xposed group was selected from those who were anti-HCV-negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study-specific questionnaire and clinical, serological, virological, and biochemical assess ment. Complete follow-up was achieved on 98 anti-HCV-pos itive individuals and 201 negatives. Injecting drug use (IDU) was the presu med route of infection. At a mean of 25 years' follow-up, 54% of the anti-H CV-positive group had evidence of chronic HCV infection (both anti-HCV- and HCV-RNA-positive); the remainder were HCV-RNA-negative, Sixty-nine percent of those chronically infected had elevated serum alanine transaminase (ALT ) levels, but only 8% had progressed to overt cirrhosis, and no cases of he patocellular carcinoma (HCC) were identified. In summary, anti-HCV-positive subjects were 8 times more likely to have died from suicide or drug overdo se than from HCV-related disease. Anti-HCV-positive study subjects were at increased risk of liver-related pathology after 25 years' follow-up, but fe w had progressed to overt cirrhotic liver disease. Excess mortality in this group was not the result of liver disease. This suggests that the natural history of community-acquired HCV may be more benign than previously though t.