Report Claims MOST HCV Patients Will Develop Cirrhosis
September 2, 2005
This is one of the most broad announcements regarding Hepatitis C I’ve seen in a long time. It appears to apply to all Hepatitis C patients.
And, while it seems to predict eventual doom and gloom for most HCV patients, it does so on a very shaky foundation.
And, oh boy, I’ve got a bit to say about the study this article refers to. Here is the actual conclusion of the study authors:
“The prevalence of cirrhosis in patients with chronic HCV increases with increasing duration of infection. In Asian patients infected at birth, infection for over 60 years causes cirrhosis in 71% of infected individuals. Because relationship between the severity of fibrosis and age in Asian patients is similar to that seen in Caucasian patients it is likely that similar rates of cirrhosis will be seen in other patients who are infected for more than 60 years.”
First of all, there is no mention of what genotype the “Asian” patients were infected with. According to data I have seen each genotype seems to progress at different rates and with differing levels of severity. 70% of North Americans have genotype 1. And Genotype 1b seems to progress differently than even 1a. And, in Asia, genotype 6 is fairly common. So, does the finding of this study really apply to genotype 1 (or 70% of Americans)?
The study also does not mention mode of infection, and other studies show there is a big difference in progression between those who were infected through transfusion and those infected through other means.
The broad conclusion of this study is that most HCV patients (up to 80%)will progress to cirrhosis after 60 to 80 years of chronic infection. Of course, this conclusion is drawn without taking into account certain variables (as mentioned above).
The actual report from Clinical Gastroenterology and Hepatology goes on to say this about one aspect of the study:
“The authors also assumed that the Asian patients were infected at a very young age, largely on the basis of extrapolation of regression lines down to an age in which patients would presumably not have had fibrosis. This conclusion is speculative and goes well beyond the data presented in the study.”
The study authors concluded that the majority of patients will progress to cirrhosis after 60 years. The Journal goes on to say this:
“Such conclusions are currently premature. Specifically, additional studies are needed in other patient populations that overcome the design limitations of the current study and to address the alternative interpretation of the data that, although during a lifetime there might indeed be progression to cirrhosis, this might only seldom result in end-stage liver disease or the development of HCC.”
So, while this looks pretty bad at first glance, closer scrutiny helps put it in clearer perspective.
Oh, one more thing. Most Americans were infected in their early 20’s. 60 to 80 years puts them into their 80s to over 100. Hmmm, with an average life expectancy in this country of 72, it seems like HCV patients may do even better than average (wink).
Just shows you’ve got to take these preliminary study conclusions with a grain of salt. (By the way, be sure you note who helped sponsor this study. The info is near the bottom.)
American Gastroenterological Association
Most chronic hepatitis C sufferers will develop cirrhosis in later life
Study suggests cirrhosis and liver disease nearly inevitable for people with hep C
Bethesda, Maryland (Sept. 1, 2005) – Nearly 80 percent of chronic hepatitis C sufferers who have the disease for several decades will develop cirrhosis or end-stage liver disease later in life, according to a study published today in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology. Researchers found that it is highly likely that people who are infected with hepatitis C (HCV) for more than 60 years will develop cirrhosis–the highest rate of hepatitis C-associated cirrhosis reported to date.
Hepatitis C is a virus that affects the liver and is spread primarily by contact with blood and blood products in transfusions and among drug users who share needles. Other common routes of transmission are infants born to HCV-infected mothers, tattoos and body piercings and risky sexual behavior. Of those who are infected, more than 80 percent will be chronic carriers of the disease.
HCV can cause long-term scarring of the liver and usually presents with mild and non-specific symptoms, if any. They include fatigue, nausea, poor appetite and muscle and joint pain. It is estimated that more than 4 million Americans are now infected with HCV (more than 170 million people worldwide) and nearly 10,000 Americans die from the disease each year.
“Hepatitis C begins generally as a silent acute infection, with a fraction of the patients developing cirrhosis, end-stage liver disease or liver cancer,” according to an editorial appearing in this month’s journal. “Although this is a generally accepted scenario in persons infected with HCV, there remains uncertainty about the true frequency of evolution of liver disease and its rate of progression.”
According to results of the study from researchers at the Queen Mary’s School of Medicine and Dentistry in London, the prevalence of cirrhosis in patients with chronic HCV increases with the duration of the disease. Nearly 80 percent of Asian patients who were infected at birth and lived with the disease for 60 years or more developed cirrhosis–a finding that researchers say can be applied to the general population because of the similarity in the way the disease progresses in all ethnic groups.
“This study suggests that prolonged infection with hepatitis C leads to cirrhosis in the majority of those who are infected,” said Graham R. Foster, PhD, FRCP, study author and professor of hepatology at Queen Mary’s School of Medicine and Dentistry in London. “While previous studies have found differences in disease progression in various ethnic groups, our findings confirm that fibrosis progression is the same across these groups and leads to development of cirrhosis and liver disease at the same rate in everyone.”
Researchers conducted retrospective analyses of 382 patients diagnosed with hepatitis C at three hospitals in northeast London between 1992 and 2003. Study participants were divided into two groups: Asian patients presumably infected in childhood and Caucasian patients. While the prevalence of cirrhosis in Caucasian patients was similar to the findings of previous studies, the statistics in Asians were markedly higher than previously found. The higher prevalence was partially attributed to the longer duration of HCV in the Asian patient population, those patients having suffered with the disease nearly 30 years more than the Caucasian subjects.
This study was funded by local investigators and an unrestricted research grant from Roche Pharmaceuticals.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. The AGA’s 14,500 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. On a monthly basis, the AGA publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The AGA’s annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology. For more information, visit www.cghjournal.org.