HCV natural history: The retrospective and prospective in perspective

Abstract

The key word in this Editorial, ‘iatrogenic,’ is derived from the Greek ‘iatros’ meaning physician and ‘genic’ meaning ‘produced by’ or ‘related to.’ In addition, in current usage, an iatrogenic occurrence must be unintended. Thus, the Merriam Webster definition of iatrogenic is, ‘induced inadvertently by a physician, surgeon, medical treatment or diagnostic procedure’. Two almost identical and temporally related inatrogenic events involving HCV-contaminated lots of Rh immunoglobulin occurred in Ireland and Germany in the late 1970’s. Thousands of women were inadvertently infected with HCV and these ‘experiments in nature’ have, through diligent investigation and long-term follow-up, provided enormous insights into the natural history of HCV infection. The long-term outcomes of HCV infection have had differing interpretations during the decades since the predecessor virus, non-A, non-B, was first recognized [1]. In the 1970’s, non-A, non-B hepatitis (NANBH) was viewed by many as an asymptomatic illness of minor consequence; some considered it merely a non-specific transaminitis. However, as these cases were followed prospectively, it became clear that as many as 20% evolved into cirrhosis [2]. This dramatic outcome stimulated clinical interest in NANBH and in the 1980’s increasingly dire reports of severe outcomes emerged. In a now classic study by Tong et al. [3] 46% of post-transfusion hepatitis cases had biopsy evidence of cirrhosis and 11% had hepatocellular carcinoma. However, this and similar severe outcome data in the 1980’s, reflected referral bias rather than worsening prognosis. Because of early treatment trials and the emergence of specialized hepatitis centers, the most severe cases of