Hepatitis activity index is a key factor in determining the natural history of chronic hepatitis C

To analyze the spontaneous pathologic progression of chronic hepatitis C, w e analyzed the histopathologic semiquantitative scores (Metavir and Knodell ) of sequential liver biopsies performed in untreated hepatitis C virus (HC V)-infected patients. Subjects included 35 men and 41 women, with a mean ag e of 41 +/- 12 years, a duration of HGV infection of 11 +/- 5 years, and an interval between liver biopsies of 3.7 +/- 2.5 years. Results obtained usi ng the Knodell score and the Metavir score were similar. At the first biops y, 78.9% of patients had a low activity score (AO-Al) and 82.9% had a low f ibrosis score (F0-F2). At the second biopsy, the activity decreased in 9.2% , was unchanged in 72.4%, and increased in 18.5%. An increase in activity w as more frequently observed in patients infected with genotype I (28.9%) th an with others (7.7%; P = .04); the yearly progression of activity was sign ificantly higher in patients with a low rather than high initial activity s core (0.11 v -0.02; P < .01). An increase in fibrosis was noted in 13.3% of those with a low and 43.8% of those with a high initial activity score (P < .01), with a highest rate of yearly fibrosis progression (0.12 U). In mul tivariate analysis, only a high activity score was significantly associated with an increased risk of fibrosis progression (relative risk, 25.5; 95% c onfidence interval, 2.7 to 238; P = .004). Spontaneous chronic hepatitis C evolution is worsening in only 20% of patients. Fibrosis progression is sig nificantly associated with the necroinflammatory activity suggesting that t his factor should be regarded as a major clue for deciding therapy. Copyrig ht (C) 2001 by W.B. Saunders Company