Clinical course of hepatitis C virus during the first decade ofinfection: cohort study
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Clinical course of hepatitis C virus during the first decade of
infection: cohort study
Objective: To determine the clinical course of hepatitisC
virus in the first decade of infection in a group of patientswho
acquired their infections on a knowndate. Design: Cohortstudy. Setting: Clinical centres throughout the UnitedKingdom. Participants: 924 transfusion recipients infected with thehepatitis
C virus (HCV) traced during the HCV lookback programmeand
475 transfusion recipients who tested negative for antibodiesto
HCV(controls). Main outcome measures: Clinical evidence of liver disease and survivalafter 10 years ofinfection. Results: All cause mortality was not significantlydifferent
between patients and controls (Cox's hazards ratio 1.41,95%
confidence interval 0.95 to 2.08). Patients were more likelyto
be certified with a death related to liver disease than werecontrols
(12.84, 1.73 to 95.44), but although the risk of deathdirectly
from liver disease was higher in patients than controlsthis
difference was not significant (5.78, 0.72 to 46.70). Fortyper
cent of the patients who died directly from liver diseasewere known
to have consumed excess alcohol. Clinical follow upof
826 patients showed that liver function was abnormal in 307(37.2%),
and 115 (13.9%) reported physical signs or symptoms ofliver
disease. Factors associated with developing liver diseasewere
testing positive for HCV ribonucleic acid (odds ratio 6.44,2.67 to
15.48), having acquired infection when older (at age 40 years;
1.80, 1.14 to 2.85), and years since transfusion (oddsratio
1.096 per year, 1.00 to 1.20). For patients with severedisease,
sex was also significant (odds ratio for women 0.38,0.17 to
0.88). Of the 362 patients who had undergone liver biopsy,328 (91%)
had abnormal histological results and 35 (10%) of thesewerecirrhotic. Conclusions: Hepatitis C virus infection did not have agreat
impact on all cause mortality in the first decade of infection.Infected
patients were at increased risk of dying directly fromliver
disease, particularly if they consumed excess alcohol, butthis
difference was not statisticallysignificant.
What is already known on this topic
The clinical course of HCV infection is unclear because most information has
come from studies of patients with established chronic liver disease
Studies that follow patients from disease onset are rare because most HCV
infections are asymptomatic
What this study adds
HCV infection does not have a great impact on all cause mortality in the
first decade of infection
Infected patients have an increased risk of dying from a liver related
cause, particularly if they consumed excess alcohol
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