Liver, Pancreas and Biliary TractNatural course of acute hepatitis C: a long-term prospective study
Introduction
Acute hepatitis C (AHC) is usually asymptomatic and therefore remains unrecognised in most infected individuals. Although more than 10 years have passed since the identification of hepatitis C virus (HCV), this silent onset explains why the natural history of acute hepatitis C is still poorly characterised [1]. Moreover, diagnosis of acute HCV infection is often problematic because there are no serological markers which can distinguish acute hepatitis C from an exacerbation of chronic hepatitis C. Both these issues are responsible for the difficulty in organising large patient studies which are necessary to produce guidelines for clinical management and treatment. The few reports available, mainly regarding transfusion-associated acute hepatitis C in which the onset of infection is clearly established, have demonstrated its marked propensity to progress to chronic hepatitis [2], [3], [4], which in turn can lead to cirrhosis and hepatocellular carcinoma [5], [6]. This high chronicity rate and evidence that treatment of patients with acute hepatitis C reduced the risk of chronic evolution [7], [8] emphasise the need to treat during early infection. However, if all acutely infected patients should be treated, and precisely when, is still unclear. Moreover, the epidemiological pattern of acute HCV infection has changed during recent years and the rate of chronic evolution of symptomatic community-acquired acute hepatitis C, most commonly seen at present, requires further evaluation.
Thus, in the present study we prospectively followed a cohort of patients with a well-defined diagnosis of acute hepatitis C acquired via various routes, to investigate the natural course, the rate of chronicity, and to identify host and virus-related factors which might predict which patients would spontaneously clear the virus or progress to chronic disease and therefore become candidates for antiviral treatment.
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Patients
Among the patients referred to our institute from March 1995 to March 2000, acute hepatitis C was diagnosed in 40 consecutive HCV RNA positive patients (23 males, 17 females, mean age 40 years, range 14–75) who fulfilled the following criteria; (a) documented seroconversion to HCV antibodies (anti-HCV) or alternatively (b) abrupt increase of transaminase serum levels (more than 20 times the upper normal value), and absence of any other cause of acute liver damage in previously healthy
Clinical course and outcome
At presentation, 24/40 patients (60%) had symptomatic disease; fatigue was the most common symptom occurring in 15/24 patients (63%), followed by dyspepsia (in 9/24; 38%) and abdominal pain (4/24; 17%). One patient had a severe thrombocytopenia causing metrorrhagia. Jaundice was noted in 20 subjects (50%). Bilirubin levels were between 2.5 and 10 mg/dl in 10 patients, >10 mg/dl and <20 mg/dl in six patients, and >20 mg/dl in four patients. The median ALT value was 1509 IU/ml (range 200 to 3724
Discussion
In this study, a cohort of 40 consecutive patients from the same endemic area (Apulia, Italy) with a well-defined diagnosis of acute hepatitis C was prospectively followed from the early disease phase up to a median period of 35 months. As the patients were referred to our clinic on account of a possible acute hepatitis, they might not represent the overall spectrum of patients with acute hepatitis C; however, the inclusion in our study of both symptomatic and asymptomatic forms of acute
Conflict of interest statement
None declared.
Acknowledgements
Supported by the European Community Project No. QLK2-CT-1999-00356. The authors are grateful to Ms. Paulene Butts for her assistance in the preparation of the manuscript.
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