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Prediction of clinical outcome in advanced hepatitis C-associated liver disease: identification of patients at the highest need for antiviral treatment and surveillance
  1. Christoph Neumann-Haefelin,
  2. Robert Thimme
  1. Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
  1. Correspondence to Dr Robert Thimme, Department of Medicine II, University Hospital Freiburg, Hugstetter Str. 55, Freiburg 79106, Germany; robert.thimme{at}uniklinik-freiburg.de

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Patients infected with HCV usually have a long period of mild disease of 15–25 years. After this period, a substantial number of patients develop liver-associated morbidity and mortality, including clinical complications of liver cirrhosis such as ascites, variceal haemorrhage, hepatic encephalopathy, hepatocellular carcinoma (HCC) or liver-related death. This natural course of disease has been best described in young and mostly healthy women who were infected by a contaminated anti-D immunoglobulin preparation in East Germany in 1978/1979. Less than 2% of women with chronic HCV infection developed liver cirrhosis or HCC in the first 25 years of infection, while this number increased substantially to approximately 15% in the 35-year follow-up.1 ,2 These data were discussed controversially, since this initially mild course was partially attributed to the cohort of young, female patients with few comorbidities. A recent evaluation of a cohort of intravenous drug users (IVDU) who were followed since the 1970s, however, found a similarly slow progression of HCV-associated liver disease in this ‘real-world’ cohort. Indeed, this study analysed autopsies from 61 chronically infected subjects who had died mostly due to drug-related reasons. None of the 18 subjects who had died <15 years after HCV exposure had F3 or F4 METAVIR fibrosis stage, while 6 of 17 …

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