NATURAL HISTORY OF HCV RELATED
CHRONIC HEPATITIS IS INFLUENCED AND MODIFIED BY MANY FACTORS: virus features,
coinfections and host characteristics. In particular, a peculiar genetic background of the host by conditioning the occurrence of intracellular metabolic derangements (i.e.,
insulin resistance) might contribute to accelerate the rate of progression to
cirrhosis and eventually the occurrence of
hepatocellular carcinoma (HCC) and death. Likely, direct interplays between virus genotype and host genetic background might be hypothesized at this level. Morbidity and mortality in
cirrhosis is primarily associated with complications of
liver cirrhosis (
ascites,
hepatic encephalopathy,
jaundice, and gastroesophageal
bleeding) and HCC occurrence. Therefore the main goal of
therapy is to clear
viral infection and decrease liver necro-
inflammation that directly relates to development of
cirrhosis and HCC. Among patients treated with
Interferon-based
therapy, those with sustained viral response showed a significant reduction of progression to
cirrhosis and development of HCC. However, a residual risk of
hepatocellular carcinoma still remains indicating the need for careful follow-up using ultrasonography every six months in cirrhotic patients, even in those showing persistently normal ALT and undetectable HCV
RNA levels after
antiviral therapy.