Researchers from Italy assessed the frequency and rate of progression to cirrhosis in patients with transfusion-associated chronic hepatitis C virus (HCV) infection and identified possible negative prognostic factors.
Before the introduction of HCV screening for blood donors, the risk of acquiring HCV infection as a result of a transfusion was about 10%.
Of 2477 consecutive patients with clinical or laboratory evidence of liver disease, 392 (16%) were anti-HCV- and HCV-RNA-positive. In addition, they all had anamnestic evidence of a single and precisely dated transfusion event, and showed no other causes of chronic liver disease.
A total of 268 (68%) underwent ultrasound-guided liver biopsy and were enrolled in the study.
After a mean interval of 18.4 years, 20% of the patients had cirrhosis.
| More aggressive therapy needed in older patients infected with HCV.
Multivariate analysis showed cirrhosis to be independently associated with the duration of follow-up, age at infection and at the time of liver biopsy, and serum alanine aminotransferase levels at biopsy.
The time necessary to have a 50% probability of developing cirrhosis in patients aged 21-30, 31-40, and more than 40 years was 33, 23, and 16 years, respectively.
In comparison with those aged 20 years or less at infection, the risk ratio of developing cirrhosis over a period of 30 years for patients aged 21-30 and at least 31 years at infection was, respectively, 4.5 and 12.3.
Author Eliseo Minola said on behalf of the group, "In patients with transfusion-associated chronic hepatitis C, the risk of cirrhosis is related to age at infection and disease activity."
"Our findings suggest that an aggressive therapeutic approach should be adopted in patients infected by HCV at an older age to prevent the progression to end-stage liver disease," it was concluded.