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Study Identifies Factors that Influence Fibrosis Progression in HCV

In patients with hepatitis C virus (HCV), fibrosis progression is highest in patients with early-stage fibrosis and those who have had at least one alanine aminotransferase (ALT) flare (>200U/L). Further, HIV co-infection is not associated with accelerated progression, according to recent research.

HCV can cause fibrosis, cirrhosis, cancer, and death. However, risk factors that influence fibrosis progression in patients with HCV are poorly understood.
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To investigate factors that influence fibrosis progression, the researchers conducted a retrospective study of 378 patients with HCV who had had 2 or more liver biopsies between 1997 and 2013. The majority of patients was male (59.3%), was Caucasian (59.9%), and had geneotype-1 HCV (86.7%). Thirty-one percent of the participants had co-infection with HIV.

Of the 936 biopsies included in the analysis, 57.4% showed fibrosis progression, and 5.8% showed cirrhosis.

Fibrosis progression between the first and last biopsies was associated with lower fibrosis stage at the first biopsy and with at least one ALT flare.

The highest fibrosis progression rate was between stages 0 (no fibrosis) and 1 (mild), and the lowest rate was between stages 2 (moderate) and 3 (severe). Increased necrosis and inflammation and higher ALT levels were associated with faster progression.

No association between HIV co-infection and fibrosis progression was observed.

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

—Amanda Balbi

Reference:

Zeremski M, Dimova RB, Pillardy J, de Jong YP, Jacobson IM, Talal AH. Fibrosis progression in patients with chronic hepatitis C virus infection [published online August 2, 2016]. J Infect Dis. doi:10.1093/infdis/jiw332.