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. 2003 Apr;52(4):574-9.
doi: 10.1136/gut.52.4.574.

Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: a cross sectional and longitudinal study

M Wright  1 , R Goldin, A Fabre, J Lloyd, H Thomas, C Trepo, P Pradat, M Thursz; HENCORE collaboration
Affiliations

Measurement and determinants of the natural history of liver fibrosis in hepatitis C virus infection: a cross sectional and longitudinal study

M Wright et al. Gut. 2003 Apr.

Abstract

Introduction: The rate of development of liver fibrosis in hepatitis C virus (HCV) infection varies between individuals. This accounts for the variation in duration of progression to cirrhosis. The aims of this study were: (1) to determine whether fibrosis progresses linearly through the grading scales and (2) to identify factors which influence the rate of fibrosis.

Methods: HCV infected patients who had undergone at least one liver biopsy were identified. Biopsies were scored using the modified HAI (Ishak) and METAVIR systems, which were compared. Patients were treatment naïve at first biopsy. Demographic features were examined for their relationship to fibrosis rate (defined as fibrosis stage/infection duration) using univariate and multivariate analysis. A subgroup of patients with two biopsies was examined to test the assumption that fibrosis progresses in a linear fashion.

Results: A total of 917 patients were included. Male sex (p<0.00001), older age at infection (p</=0.00001), and viral genotype non-1 (p=0.005) were all associated with a rapid rate of fibrosis. On multiple linear regression they accounted for 29.5% of the variability in fibrosis rate (r(2)=0.295). METAVIR and Ishak scores were highly correlated (r=0.935, p<0.0001). In 137 patients who had two biopsies, the predicted probability for an increase of 1 on the fibrosis score was too low to assess linearity.

Conclusions: Demographic features account for a minority of fibrosis rate variability. The Ishak and METAVIR scoring systems are equivalent. Linearity of fibrosis progression cannot be assessed in biopsies only a few years apart.

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Figures

Figure 1
Figure 1
Scatter plot of the modified HAI score against the METAVIR score. A total of 274 biopsies were assessed: r=0.959, p<0.00001. (Each spike on a point represents five cases.)
Figure 2
Figure 2
Age at time of infection plotted against the log of fibrosis rate (error bars represent 95% confidence interval).
Figure 3
Figure 3
Age at time of biopsy plotted against the log of fibrosis rate (error bars represent 95% confidence interval).
Figure 4
Figure 4
Duration of infection plotted against fibrosis score at the first biopsy.
Figure 5
Figure 5
Mean age at each fibrosis stage.
See this image and copyright information in PMC

References

    1. Seeff LB, Buskell-Bales Z, Wright EC, et al. Long-term mortality after transfusion- associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. N Engl J Med 1992;327:1906–11. - PubMed
    1. Seeff LB, Miller RN, Rabkin CS, et al. 45-year follow-up of hepatitis C virus infection in healthy young adults. Ann Intern Med 2000;132:105–11. - PubMed
    1. Tong MJ, el Farra NS, Reikes AR, et al. Clinical outcomes after transfusion- associated hepatitis C. N Engl J Med 1995;332:1463–6. - PubMed
    1. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997;349:825–32. - PubMed
    1. Foster GR, Goldin RD, Main J, et al. Management of chronic hepatitis C: clinical audit of biopsy based management algorithm. BMJ 1997;315:453–8. - PMC - PubMed

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