Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C

Background/Aims: In hepatitis C there is controversy over the linearity of the rate of progression and the significance of gender, mode of infection a nd viral factors. Methods: 2313 untreated patients with a reliable estimated duration of infe ction and liver fibrosis were included, Fibrosis progression was calculated using the Kaplan-Meier method and the rate of fibrosis progression using t he hazard function. Seven risk factors were assessed: age at biopsy, gender , alcohol consumption, mode of infection, activity grade, hepatitis C virus genotype and RNA level. Results: The percentage of patients without cirrhosis was 91% after 20 year s of infection (95 % CI:90-92 %) and 56% after 40 years (95 % CI:48-64 %), Three independent factors were associated (P < 0.001) with a faster progres sion rate: age at infection, alcohol consumption of 50 g or more per day, a nd male gender. The mode of infection, histologic activity, genotype and vi ral load were not independently associated with fibrosis, Fibrosis progress ion was mainly dependent on age and the duration of infection and can be di vided into four successive periods with very slow, slow, intermediate and r apid progression rates, Conclusion: In patients infected with hepatitis C, the majority of fibrosis progression occurred in those aged fifty years or older, (C) 2001 European Association for the Study of the Liver, Published by Elsevier Science B,V, All rights reserved.