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Natural history of liver fibrosis in hepatitis C virus infection

Researchers from England and France find that demographic features account for a minority of fibrosis rate variability.

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The rate of development of liver fibrosis in hepatitis C virus (HCV) infection varies between individuals.

In this study, researchers determined whether fibrosis progresses linearly through the grading scales. They also identified factors influencing the rate of fibrosis.

The team’s findings are published in the April issue of Gut.

The researchers identified 917 HCV infected patients, who had undergone at least 1 liver biopsy.

They scored the biopsies were scored using the modified HAI (Ishak) and METAVIR systems. These 2 systems were compared.

Male sex, older age at infection, and viral genotype are associated with more rapid fibrosis progression.
Gut

All patients were treatment naïve at first biopsy.

Researchers examined demographic features for their relationship to fibrosis rate using univariate and multivariate analysis.

In addition, a subgroup of patients who had 2 biopsies was examined to test the assumption that fibrosis progresses in a linear fashion.

The research team found that male sex, older age at infection, and viral genotype non-1 were all associated with a rapid rate of fibrosis. Using multiple linear regression, they determined that these factors accounted for 30% of the variability in fibrosis rate.

The team also found that the METAVIR and Ishak scores were highly correlated.

However, in the 137 patients who had 2 biopsies, the predicted probability for an increase of 1 on the fibrosis score was too low to assess linearity.

Dr Wright’s team concluded, “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.”

Gut 2003; 52: 574-9
13 March 2003

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