Estimating progression to cirrhosis in chronic hepatitis C... : Hepatology (original) (raw)

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Freeman, Anthony J.1; Dore, Gregory J.*,2; Law, Matthew G.2; Thorpe, Max3; Von Overbeck, Jan3; Lloyd, Andrew R.4; Marinos, George1; Kaldor, John M.2

1Viral Hepatitis Research, Gastrointestinal and Liver Unit, The Prince of Wales Hospital, Sydney, Australia

2National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia

3Swiss Re Life and Health, Zurich, Switzerland

4Inflammation Research Unit, School of Pathology, The University of New South Wales, Sydney, Australia.

E-mail: [email protected]

*Address reprint requests to: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia. fax: (61) 2-9332 1837

Received March 05, 2001; accepted July 16, 2001; previously published online December 30, 2003

Abstract

To gain a clearer understanding of the rate of progression to cirrhosis and its determinants in chronic hepatitis C virus (HCV) infection, a systematic review of published epidemiologic studies that incorporated assessment for cirrhosis has been undertaken. Inclusion criteria were more than 20 cases of chronic HCV infection, and information on either age of subjects or duration of infection. Of 145 studies examined, 57 fulfilled the inclusion criteria. Least-squares linear regression was employed to estimate rates of progression to cirrhosis, and to examine for factors associated with more rapid disease progression in 4 broad study categories: 1) liver clinic series (number of studies = 33); 2) posttransfusion cohorts (n = 5); 3) blood donor series (n = 10); and 4) community-based cohorts (n = 9). Estimates of progression to cirrhosis after 20 years of chronic HCV infection were 22% (95% CI, 18%-26%) for liver clinic series, 24% (11%-37%) for posttransfusion cohorts, 4% (1%-7%) for blood donor series, and 7% (4%-10%) for community-based cohorts. Factors that were associated with more rapid disease progression included older age at HCV infection, male gender, and heavy alcohol intake. Even after accounting for these factors, progression estimates were much higher for cross-sectional liver clinic series. Selection biases probably explain the higher estimates of disease progression in this group of studies. Community-based cohort studies are likely to provide a more representative basis for estimating disease progression at a population level. These suggest that for persons who acquire HCV infection in young adulthood, less than 10% are estimated to develop cirrhosis within 20 years. (Hepatology 2001;34:809-816.)