Is severe liver disease a common outcome for people with chronic hepatitisC?


Dr Gregory J Dore, NationalCentre in HIV Epidemiology and Clinical Research, The Universityof New South Wales, Level 2, 376 Victoria Street, Darlinghurst,NSW 2010, Australia. Email:


Abstract  For people with chronic hepatitis C, an assessment of their riskof progression to advanced liver disease is a major priority. Earlystudies of the natural history of chronic hepatitis C suggestedthat development of cirrhosis was a relatively common outcome, evenin the first 20 years of infection. These studies wereeither cross-sectional liver clinic series of people referred forassessment to specialist clinics, or longitudinal cohorts of peoplewith post-transfusion hepatitis. More recent studies (particularlylong­itudinal community-based cohorts) indicate that liverdisease progression is generally slow, and that a minority of peoplewith chronic hepatitis C will develop advanced liver disease. Basedon an extensive review of studies reporting on chronic hepatitisC natural history, we have developed a Markov model of liver diseaseprogression. This model estimates that the risk of progression tocirrhosis is 7% and 20% after 20 and 40 yearsof infection, respectively. Corresponding estimates for hepatitisC-related mortality are 1% and 4%. However, liverdisease progression is highly variable, and certain subgroups ofpeople with chronic hepatitis C are at increased risk of advancedliver disease. Those groups include people with a heavy alcoholintake, those who have coinfection with HIV or HBV, and those whohave already progressed to moderate to severe hepatic fibrosis.

© 2002 Blackwell Publishing Asia Pty Ltd