Fibrosis Progression in Patients with Chronic Hepatitis C Virus

J Infect Dis. (2016) doi: 10.1093/infdis/jiw332
First published online: August 2, 2016

Fibrosis Progression in Patients with Chronic Hepatitis C Virus

Infection Marija Zeremski1,*, Rositsa B. Dimova2,3,*, Jaroslaw Pillardy4, Ype P. de Jong1, Ira M. Jacobson5 and Andrew H. Talal1

Abstract
Background. 
Fibrosis progression varies markedly in hepatitis C virus (HCV)-infected individuals. We investigated factors that influence fibrosis progression in chronic HCV infection.

Methods. 
HCV-infected patients with at least two liver biopsies were included in this study. Associations between fibrosis progression and epidemiologic, virologic and disease-associated factors were analyzed using logistic regression and multistate Markov modeling.

Results. 
We analyzed 936 biopsies obtained from 378 individuals. Mean age at first biopsy was 48.3±9.3 years, 59.3% of patients were male, 59.9% Caucasian, and 86.7% HCV genotype 1-infected. Fibrosis progression and cirrhosis occurred in 57.4% and 5.8%, respectively. Fibrosis progression between the first and last biopsies was associated with lower fibrosis on the first biopsy (p<0.001) and with the occurrence of at least one ALT flare (>200U/L, p=0.007).

We found the highest fibrosis progression rate between stages 0 and 1 and the lowest between stages 2 and 3. Increased necroinflammation and higher ALT were associated with faster progression. HCV genotype 3-infected patients were more likely to progress to cirrhosis (p<0.001).

Conclusions. 
Fibrosis progression in HCV is not linear but varies according to stage with the highest progression in patients with the lowest fibrosis. Patients who experience ALT flares are also more likely to progress.

10.1093/infdis/jiw336