Assessment of Long-Term Outcomes of Community-Acquired Hepatitis C Infection in a Cohort With Sera Stored From 1971 to 1975

Abstract

The aim of this study was to examine the long-term effects of hepatitis C virus (HCV) infection on a cohort of patients admitted with acute viral hepatitis from 1971 through 1975. The availability of stored sera from this time enabled testing to identify those who were anti-HCV–positive on admission. Sixteen percent (n = 238) of the cohort tested anti-HCV–positive. The unexposed group was selected from those who were anti-HCV–negative. Systematic approaches were used to locate the cohort and health outcomes assessed by a study-specific questionnaire and clinical, serological, virological, and biochemical assessment. Complete follow-up was achieved on 98 anti-HCV–positive individuals and 201 negatives. Injecting drug use (IDU) was the presumed route of infection. At a mean of 25 years' follow-up, 54% of the anti-HCV–positive group had evidence of chronic HCV infection (both anti-HCV– and HCV-RNA–positive); the remainder were HCV-RNA–negative. Sixty-nine percent of those chronically infected had elevated serum alanine transaminase (ALT) levels, but only 8% had progressed to overt cirrhosis, and no cases of hepatocellular carcinoma (HCC) were identified. In summary, anti-HCV–positive subjects were 8 times more likely to have died from suicide or drug overdose than from HCV-related disease. Anti-HCV–positive study subjects were at increased risk of liver-related pathology after 25 years' follow-up, but few had progressed to overt cirrhotic liver disease. Excess mortality in this group was not the result of liver disease. This suggests that the natural history of community-acquired HCV may be more benign than previously thought.(Hepatology 2000;32:582-587.)