Outcome of liver disease in a large cohort of histologically proven chronic hepatitis C: influence of HCV genotype

Objective To assess the influence of hepatitis C virus (HCV) genotypes on t he clinical outcome of liver disease, we analysed 2307 patients. Results The most frequently represented genotypes were 1b (40%) and 2 (28.1 %). Patients with these genotypes had a median age higher than patients wit h other genotypes (P < 0.01). The overall survival of subjects with genotyp e 1b was poorer than the survival of patients with other genotypes (P < 0.0 1). Liver cirrhosis was found in 280 patients (12.1%), and type 1b was the most represented isolate among them (P < 0.01). Sixty-two patients (22%) de veloped hepatocellular carcinoma (HCC) during a follow-up of 1481.8 cumulat ive years (estimated crude incidence rate, 4.1 cases per 100 person-years f or all cirrhotics; 5.9 cases for genotype 1a; 4.5 cases for genotype 1b; an d 2.8 cases for genotypes non-1). Considering the whole population of 2307 patients, only genotype 1b was associated significantly with both cirrhosis and the development of HCC. One hundred and nineteen cirrhotic patients un derwent treatment with interferon in uncontrolled studies. Interferon thera py was associated with both better survival (P < 0.01) and a lower cumulati ve hazard for HCC (P< 0.01). Conclusions Genotype 1b was associated with a poorer prognosis, probably be cause it leads to cirrhosis and consequently to HCC development. However, o ur data did not confirm genotype 1b as an independent risk factor for HCC i n liver cirrhosis, which plays a major role in carcinogenesis. Interferon s hould be considered as a useful strategy in cirrhosis for improvement of su rvival and reduction of HCC risk. Eur J Gastroenterol Hepatol 13:501-506 (C ) 2001 Lippincott Williams & Wilkins.