The prognosis of
chronic hepatitis C virus (HCV)
infection is still ill-defined. The present study prospectively evaluated mortality and complications in a large cohort of patients with
chronic hepatitis C. The study included 838 anti-HCV and HCV-
RNA-positive patients who were followed for 50.2 +/- 26.9 months (mean +/- SD; range, 6-122 months) in a prospective protocol. During follow-up, 62 patients died (31 from
liver disease and 31 from other causes), and 12 patients needed
liver transplantation. When compared with a matched general population,
hepatitis C increased mortality mainly when
cirrhosis was present and in patients who were less than 50 years old at study entry. During follow-up, a further 30 patients developed nonlethal complications of
cirrhosis. By multivariate regression, survival was decreased by
cirrhosis, long disease duration, history of
intravenous drug abuse, and excessive alcohol consumption, whereas
interferon therapy improved survival.
Alanine transaminase (ALT),
bilirubin, sex, and genotype had no effect on survival. The risk of
hepatocellular carcinoma (HCC) (n = 17) was increased by
cirrhosis and to a lesser degree by long disease duration and high
bilirubin, whereas
interferon therapy, genotype, and other factors had no effect.
Chronic hepatitis C is a disease with considerable mortality and morbidity when
cirrhosis is present at diagnosis. Patients who acquire the
infection early in life have a markedly increased mortality even when
cirrhosis is absent at diagnosis. The age at diagnosis therefore should play a major role in therapeutic considerations. The present data also suggest that
interferon therapy has a long-term clinical benefit, although it did not reduce the risk of
liver cancer.