Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis C.

Autores:	Pierre-Yves Bochud, Tao Cai, Kathrin Overbeck, Murielle Bochud, Jean-François Dufour, Beat Müllhaupt, Jan Borovicka, Markus Heim, Darius Moradpour, Andreas Cerny, Raffaele Malinverni, Patrick Francioli, Francesco Negro
Língua:	Eng.
Data:	2009-09-15
Jornal:	Journal of Hepatology (0168-8278)
Release:	J Hepatol. 2009 Oct;51(4):655-66
Abstract:	BACKGROUND/ AIMS: While several risk factors for the histological progression of chronic hepatitis C have been identified, the contribution of HCV genotypes to liver fibrosis evolution remains controversial. The aim of this study was to assess independent predictors for fibrosis progression. METHODS: We identified 1189 patients from the Swiss Hepatitis C Cohort database with at least one biopsy prior to antiviral treatment and assessable date of infection. Stage-constant fibrosis progression rate was assessed using the ratio of fibrosis Metavir score to duration of infection. Stage-specific fibrosis progression rates were obtained using a Markov model. Risk factors were assessed by univariate and multivariate regression models. RESULTS: Independent risk factors for accelerated stage-constant fibrosis progression (>0.083 fibrosis units/year) included male sex (OR=1.60, [95% CI 1.21-2.12], P<0.001), age at infection (OR=1.08, [1.06-1.09], P<0.001), histological activity (OR=2.03, [1.54-2.68], P<0.001) and genotype 3 (OR=1.89, [1.37-2.61], P<0.001). Slower progression rates were observed in patients infected by blood transfusion (P=0.02) and invasive procedures or needle stick (P=0.03), compared to those infected by intravenous drug use. Maximum likelihood estimates (95% CI) of stage-specific progression rates (fibrosis units/year) for genotype 3 versus the other genotypes were: F0-->F1: 0.126 (0.106-0.145) versus 0.091 (0.083-0.100), F1-->F2: 0.099 (0.080-0.117) versus 0.065 (0.058-0.073), F2-->F3: 0.077 (0.058-0.096) versus 0.068 (0.057-0.080) and F3-->F4: 0.171 (0.106-0.236) versus 0.112 (0.083-0.142, overall P<0.001). CONCLUSIONS: This study shows a significant association of genotype 3 with accelerated fibrosis using both stage-constant and stage-specific estimates of fibrosis progression rates. This observation may have important consequences for the management of patients infected with this genotype.
Copyright:	Journal of Hepatology Department of Internal Medicine, Infectious Diseases Service, CHUV, Lausanne, Switzerland.
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Assuntos	Adult, Cohort Studies, Disease Progression, Female, Fibrosis, Genotype, Hepacivirus, Hepatitis C, Chronic, Humans, Linear Models, Logistic Models, Male, Middle Aged, Risk Factors, Switzerland, Time Factors, Young Adult