Natural history of hepatitis C
TL;DR: In this paper, the authors provided varying estimates of the risk of progression in chronic hepatitis C. The combined population data indicated that the disease progresses slowly over approximately 30 years, on average.
About: This article is published in The American Journal of Medicine.The article was published on 1999-12-27. It has received 1313 citations till now. The article focuses on the topics: Hepatitis C & Coinfection.
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TL;DR: This document has been approved by the AASLD, the Infectious Diseases Society of America, and the American College of Gastroenterology.
3,013 citations
TL;DR: The data suggest that host genetics may be useful for the prediction of drug response, and they also support the investigation of the role of IL28B in the treatment of HCV and in other diseases treated with IFN-α.
Abstract: Hepatitis C virus (HCV) infects 3% of the world's population. Treatment of chronic HCV consists of a combination of PEGylated interferon-alpha (PEG-IFN-alpha) and ribavirin (RBV). To identify genetic variants associated with HCV treatment response, we conducted a genome-wide association study of sustained virological response (SVR) to PEG-IFN-alpha/RBV combination therapy in 293 Australian individuals with genotype 1 chronic hepatitis C, with validation in an independent replication cohort consisting of 555 individuals. We report an association to SVR within the gene region encoding interleukin 28B (IL28B, also called IFNlambda3; rs8099917 combined P = 9.25 x 10(-9), OR = 1.98, 95% CI = 1.57-2.52). IL28B contributes to viral resistance and is known to be upregulated by interferons and by RNA virus infection. These data suggest that host genetics may be useful for the prediction of drug response, and they also support the investigation of the role of IL28B in the treatment of HCV and in other diseases treated with IFN-alpha.
1,858 citations
01 Jan 2013
TL;DR: The EASL CPGs on the management of HCV infection will be updated on a regular basis upon approval of additional novel therapies, and will apply to therapies that are approved at the time of their publication.
Abstract: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide [1]. The long-term hepatic impact of HCV infection is highly variable, from minimal changes to chronic hepatitis, extensive fibrosis, and cirrhosis with or without hepatocellular carcinoma (HCC). The number of chronically infected persons worldwide may exceed 200 million, but most of them have no knowledge of their infection or of the ensuing hepatic condition. Clinical care for patients with HCV-related liver disease has advanced considerably during the last two decades, as a result of growing knowledge about the mechanisms of the disease, remarkable developments in diagnostic procedures, and advances in therapeutic and preventative approaches. Still, various aspects are not yet completely resolved. These EASL Clinical Practice Guidelines (CPGs) are intended to assist physicians and other healthcare providers, as well as patients and interested individuals, in the clinical decision-making process by describing optimal management of patients with acute and chronic HCV infections. These guidelines apply to therapies that are approved at the time of their publication. Several new therapeutic options have completed phase III development for patients infected with HCV genotype 1 and are currently awaiting licensing and approval in Europe and the United States. Therefore, the EASL CPGs on the management of HCV infection will be updated on a regular basis upon approval of additional novel therapies.
1,407 citations
Cites background from "Natural history of hepatitis C"
...Supportive care Before starting antiviral therapy, patients must be instructed about the schedule and the side effects to be expected during treatment....
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Institute for Health Metrics and Evaluation1, University of Washington2, University College London3, Qatar Foundation4, Mashhad University of Medical Sciences5, Queen Elizabeth Hospital Birmingham6, University of Otago7, University of Melbourne8, Johns Hopkins Bayview Medical Center9, Universiti Sains Malaysia10, Burnet Institute11, George Mason University12, Dartmouth College13, Tehran University of Medical Sciences14, University of Bristol15, University of California, San Diego16, University of Texas Southwestern Medical Center17, Environment Agency18, University of Chicago19, Erasmus University Rotterdam20, Cancer Treatment Centers of America21, Case Western Reserve University22, Bayer23, Tufts Medical Center24, Stanford University25, National Research University – Higher School of Economics26, Centers for Disease Control and Prevention27, Jackson State University28, Wuhan University29, Mansoura University30, Imperial College London31
TL;DR: The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.
1,081 citations
TL;DR: A combination of easily accessible variables accurately predicts the absence of significant fibrosis and might render liver biopsy unnecessary in more than one third of patients with chronic hepatitis C.
1,060 citations
Additional excerpts
...3%) AST (IU/L) 57 (41-84) 53 (41-74) 56 (41-84) ALT (IU/L) 97 (66-149) 90 (64-135) 95 (66-149) Gamma-GT (IU/L) 38 (24-68) 41 (22-68) 38 (24-68) Bilirubin (mg/dL) 0....
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...001 Gamma-GT (IU/L) 33 (23-57) 52 (31-117) ....
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References
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TL;DR: A random-primed complementary DNA library was constructed from plasma containing the uncharacterized non-A, non-B hepatitis agent and screened with serum from a patient diagnosed with NANBH, showing consistent with the agent being similar to the togaviridae or flaviviridae.
Abstract: A random-primed complementary DNA library was constructed from plasma containing the uncharacterized non-A, non-B hepatitis (NANBH) agent and screened with serum from a patient diagnosed with NANBH. A complementary DNA clone was isolated that was shown to encode an antigen associated specifically with NANBH infections. This clone is not derived from host DNA but from an RNA molecule present in NANBH infections that consists of at least 10,000 nucleotides and that is positive-stranded with respect to the encoded NANBH antigen. These data indicate that this clone is derived from the genome of the NANBH agent and are consistent with the agent being similar to the togaviridae or flaviviridae. This molecular approach should be of great value in the isolation and characterization of other unidentified infectious agents.
6,814 citations
TL;DR: This research presents a meta-analysis of Anatomia e Istologia Patologica, a large quantity of which has never before been published in a peer-reviewed journal, which aims to provide real-time information about the immune system’s response to disease.
4,655 citations
Additional excerpts
...Various systems have been developed to standardize liver disease grading; fibrosis scores are probably the most important marker of progression of HCV-related liver disease [116–118]....
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TL;DR: A Histology Activity Index has been developed which generates a numerical score for liver biopsy specimens obtained from patients with asymptomatic chronic active hepatitis that provides definitive endpoints for statistical analysis of serial changes in liver histology and offers an alternative to the use of conventional pathological descriptions.
3,473 citations
"Natural history of hepatitis C" refers background in this paper
...It provides important information on inflammation, fibrosis, fat, and other forms of liver disease [43,45,116]....
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...Various systems have been developed to standardize liver disease grading; fibrosis scores are probably the most important marker of progression of HCV-related liver disease [116–118]....
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TL;DR: The strongest factors independently associated with HCV infection were illegal drug use and high-risk sexual behavior, and poverty, having had 12 or fewer years of education, and having been divorced or separated were independently associated.
Abstract: Background Because many persons with chronic hepatitis C virus (HCV) infection are asymptomatic, population-based serologic studies are needed to estimate the prevalence of the infection and to develop and evaluate prevention efforts. Methods We performed tests for antibody to HCV (anti-HCV) on serum samples from 21,241 persons six years old or older who participated in the third National Health and Nutrition Examination Survey, conducted during 1988 through 1994. We determined the prevalence of HCV RNA by means of nucleic acid amplification and the genotype by means of sequencing. Results The overall prevalence of anti-HCV was 1.8 percent, corresponding to an estimated 3.9 million persons nationwide (95 percent confidence interval, 3.1 million to 4.8 million) with HCV infection. Sixty-five percent of the persons with HCV infection were 30 to 49 years old. Seventy-four percent were positive for HCV RNA, indicating that an estimated 2.7 million persons in the United States (95 percent confidence interval, ...
3,014 citations
TL;DR: The host factors of ageing, alcohol consumption, and male sex have a stronger association with fibrosis progression than virological factors in HCV infection.
3,008 citations
"Natural history of hepatitis C" refers background or result in this paper
...Perhaps the chief determinant of fibrosis progression is the age at which infection occurs [23,60,65]....
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...In contrast, in studies that have included persons across wide age ranges, higher cirrhosis rates are consistently found in those who are older, even after accounting for duration of infection [65]....
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...A comparison of biopsy scores with estimates of duration of infection has led to the conclusion that fibrosis progresses linearly [65]....
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