Hepatitis C natural history: Difference between revisions
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{{Hepatitis C}} | {{Hepatitis C}} | ||
{{CMG}} | {{CMG}} '''Associate Editor(s)-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]]; [[User:Sergekorjian|Serge Korjian]] | ||
==Overview== | |||
The majority of individuals infected with [[HCV]] will become chronic carriers. The most important complications of HCV are [[hepatic]], namely [[liver cirrhosis]] years after the onset of infection and consequent development of [[hepatocellular carcinoma]]. Other classical extrahepatic manifestations, such as [[cryoglobulinemia]], [[lichen planus]], [[membranoproliferative glomerulonephritis]], and [[porphyria cutanea tarda]] are also complications of [[chronic HCV infection]]. Treatment is necessary for patients with chronic stable HCV infection; otherwise prognosis is poor and progression of disease is potentially fatal. | |||
==Natural History== | ==Natural History== | ||
Upon exposure, HCV causes an acute phase that is asymptomatic in approximately 80% of cases. Acute | Upon exposure, HCV causes an acute phase that is asymptomatic in approximately 80% of cases. Acute HCV is characterized by its persistence to a duration of less than 6 months. In 15-45% of cases, HCV is an isolated acute infection almost with no chronic sequelae, even if no treatment was administered whatsoever. Patients exposed to HCV will subsequently develop [[anti-HCV antibodies]] but undetectable viral levels and [[negative HCV RNA]]. | ||
In the majority of cases, however, HCV persists beyond 6 months and individuals thus become chronic carriers of HCV. Chronic HCV occurs in approximately 55-85% of patients. These patients will have positive anti-HCV antibodies and positive nucleic acid test (NAT) for HCV RNA, demonstrating the persistence of HCV and inability to appropriately clear the infection.<ref name="pmid21139063">{{cite journal| author=Thomson EC, Fleming VM, Main J, Klenerman P, Weber J, Eliahoo J et al.| title=Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men. | journal=Gut | year= 2011 | volume= 60 | issue= 6 | pages= 837-45 | pmid=21139063 | doi=10.1136/gut.2010.217166 | pmc=PMC3095479 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21139063 }} </ref><ref name="pmid12851873">{{cite journal| author=Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Jung MC, Ulsenheimer A et al.| title=Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. | journal=Gastroenterology | year= 2003 | volume= 125 | issue= 1 | pages= 80-8 | pmid=12851873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12851873 }} </ref> | In the majority of cases, however, HCV persists beyond 6 months and individuals thus become chronic carriers of HCV. [[Chronic HCV]] occurs in approximately 55-85% of patients. These patients will have positive [[anti-HCV antibodies]] and positive [[nucleic acid test]] ([[NAT]]) for [[HCV RNA]], demonstrating the persistence of HCV and inability to appropriately clear the infection.<ref name="pmid21139063">{{cite journal| author=Thomson EC, Fleming VM, Main J, Klenerman P, Weber J, Eliahoo J et al.| title=Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men. | journal=Gut | year= 2011 | volume= 60 | issue= 6 | pages= 837-45 | pmid=21139063 | doi=10.1136/gut.2010.217166 | pmc=PMC3095479 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21139063 }} </ref><ref name="pmid12851873">{{cite journal| author=Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Jung MC, Ulsenheimer A et al.| title=Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. | journal=Gastroenterology | year= 2003 | volume= 125 | issue= 1 | pages= 80-8 | pmid=12851873 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12851873 }} </ref> | ||
[[Image:HCV_NH.png|thumb|600px|center|Natural History of HCV [http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/ Source]]] | [[Image:HCV_NH.png|thumb|600px|center|Natural History of HCV [http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/ Source]]] | ||
<br> | <br> | ||
==Prognosis== | ==Prognosis== | ||
===Acute HCV Infection<ref name="pmid16614742">{{cite journal| author=Chen SL, Morgan TR| title=The natural history of hepatitis C virus (HCV) infection. | journal=Int J Med Sci | year= 2006 | volume= 3 | issue= 2 | pages= 47-52 | pmid=16614742 | doi= | pmc=PMC1415841 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614742 }} </ref>=== | ===Acute HCV Infection<ref name="pmid16614742">{{cite journal| author=Chen SL, Morgan TR| title=The natural history of hepatitis C virus (HCV) infection. | journal=Int J Med Sci | year= 2006 | volume= 3 | issue= 2 | pages= 47-52 | pmid=16614742 | doi= | pmc=PMC1415841 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614742 }} </ref>=== | ||
*Clearance of HCV RNA: 15-45% | *Clearance of [[HCV RNA]]: 15-45% | ||
*Progression to chronic infection: 55-85% | *Progression to chronic infection: 55-85% | ||
*Fulminant Hepatitis: Rare | *[[Fulminant Hepatitis]]: Rare | ||
===Chronic HCV Infection<ref name="pmid16614742">{{cite journal| author=Chen SL, Morgan TR| title=The natural history of hepatitis C virus (HCV) infection. | journal=Int J Med Sci | year= 2006 | volume= 3 | issue= 2 | pages= 47-52 | pmid=16614742 | doi= | pmc=PMC1415841 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614742 }} </ref>=== | ===Chronic HCV Infection<ref name="pmid16614742">{{cite journal| author=Chen SL, Morgan TR| title=The natural history of hepatitis C virus (HCV) infection. | journal=Int J Med Sci | year= 2006 | volume= 3 | issue= 2 | pages= 47-52 | pmid=16614742 | doi= | pmc=PMC1415841 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16614742 }} </ref>=== | ||
*Cirrhosis after 20 years: 10-20% | *[[Cirrhosis]] after 20 years: 10-20% | ||
*Decompensated cirrhosis: 50% survival rate at 5 years | *[[Decompensated cirrhosis]]: 50% survival rate at 5 years | ||
*Hepatocellular carcinoma: 1-4% per year | *[[Hepatocellular carcinoma]]: 1-4% per year | ||
==Complications== | ==Complications== | ||
One major complications of chronic HCV infection are cirrhosis, which ultimately lead to a decompensated state, or transform into a malignant hepatocellular carcinoma (HCC).<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref> Not all patients develop cirrhosis at the same rate; exposure to other risk factors of cirrhosis, such as alcohol, HBV or HIV infection, or immunocompromised states may hasten fibrosis of the liver and development of HCC.<ref name="pmid12823595">{{cite journal| author=Freeman AJ, Law MG, Kaldor JM, Dore GJ| title=Predicting progression to cirrhosis in chronic hepatitis C virus infection. | journal=J Viral Hepat | year= 2003 | volume= 10 | issue= 4 | pages= 285-93 | pmid=12823595 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12823595 }} </ref> | One major complications of chronic HCV infection are cirrhosis, which ultimately lead to a decompensated state, or transform into a malignant hepatocellular carcinoma (HCC).<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref> Not all patients develop cirrhosis at the same rate; exposure to other risk factors of cirrhosis, such as [[alcohol]], [[HBV]] or [[HIV infection]], or [[immunocompromised states]] may hasten fibrosis of the liver and development of HCC.<ref name="pmid12823595">{{cite journal| author=Freeman AJ, Law MG, Kaldor JM, Dore GJ| title=Predicting progression to cirrhosis in chronic hepatitis C virus infection. | journal=J Viral Hepat | year= 2003 | volume= 10 | issue= 4 | pages= 285-93 | pmid=12823595 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12823595 }} </ref> | ||
Chronic HCV eventually progresses to cause hepatic cirrhosis due to persistence of tissue inflammation and necrosis, along with fibrogenesis and deposition of components in the extracellular matrix. When left untreated, '''15-30% of patients with chronic HCV develop cirrhosis within 20 years.'''<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref> | Chronic HCV eventually progresses to cause hepatic cirrhosis due to persistence of tissue [[inflammation]] and [[necrosis]], along with [[fibrogenesis]] and deposition of components in the [[extracellular matrix]]. When left untreated, '''15-30% of patients with chronic HCV develop cirrhosis within 20 years.'''<ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref> | ||
Similarly, HCC is a known complication of chronic HCV infection. Patients with HCV develop HCC when the liver reaches its cirrhotic stage. The annual risk of HCC in patients with cirrhosis is about 2-4%. | Similarly, HCC is a known complication of chronic HCV infection. Patients with HCV develop HCC when the liver reaches its cirrhotic stage. The annual risk of HCC in patients with cirrhosis is about 2-4%. | ||
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====Extrahepatic complications of HCV infection<ref name="pmid22497808">{{cite journal| author=Fletcher NF, McKeating JA| title=Hepatitis C virus and the brain. | journal=J Viral Hepat | year= 2012 | volume= 19 | issue= 5 | pages= 301-6 | pmid=22497808 | doi=10.1111/j.1365-2893.2012.01591.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22497808 }} </ref><ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref>:==== | ====Extrahepatic complications of HCV infection<ref name="pmid22497808">{{cite journal| author=Fletcher NF, McKeating JA| title=Hepatitis C virus and the brain. | journal=J Viral Hepat | year= 2012 | volume= 19 | issue= 5 | pages= 301-6 | pmid=22497808 | doi=10.1111/j.1365-2893.2012.01591.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22497808 }} </ref><ref name=WHO>{{cite web |url=http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1 |title=Guidelines for the screening, care, and treatment of persons with HCV infection|date=April 2014 |website=WHO |publisher=WHO |accessdate=Jul 27 2014}}</ref>:==== | ||
*Cryoglobulinemia | *[[Cryoglobulinemia]] | ||
* | *[[Membranoproliferative glomerulonephritis]] | ||
* | *[[Autoimmune thyroiditis]] | ||
*Sjogren syndrome | *[[Sjogren syndrome]] | ||
*Insulin resistance and type-2 diabetes mellitus | *[[Insulin resistance]] and [[type-2 diabetes mellitus]] | ||
*Porphyria cutanea tarda | *[[Porphyria cutanea tarda]] | ||
*Lichen Planus | *[[Lichen Planus]] | ||
*Hodgkin's and non-Hodgkin's lymphoma | *[[Hodgkin's lymphoma]] and [[non-Hodgkin's lymphoma]] | ||
*Seronegative arthritis | *[[Seronegative arthritis]] | ||
*Cognitive dysfunction | *[[Cognitive dysfunction]] | ||
*Depression | *[[Depression]] | ||
==References== | ==References== |
Revision as of 06:10, 28 July 2014
Hepatitis C |
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Hepatitis C natural history On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Yazan Daaboul; Serge Korjian
Overview
The majority of individuals infected with HCV will become chronic carriers. The most important complications of HCV are hepatic, namely liver cirrhosis years after the onset of infection and consequent development of hepatocellular carcinoma. Other classical extrahepatic manifestations, such as cryoglobulinemia, lichen planus, membranoproliferative glomerulonephritis, and porphyria cutanea tarda are also complications of chronic HCV infection. Treatment is necessary for patients with chronic stable HCV infection; otherwise prognosis is poor and progression of disease is potentially fatal.
Natural History
Upon exposure, HCV causes an acute phase that is asymptomatic in approximately 80% of cases. Acute HCV is characterized by its persistence to a duration of less than 6 months. In 15-45% of cases, HCV is an isolated acute infection almost with no chronic sequelae, even if no treatment was administered whatsoever. Patients exposed to HCV will subsequently develop anti-HCV antibodies but undetectable viral levels and negative HCV RNA.
In the majority of cases, however, HCV persists beyond 6 months and individuals thus become chronic carriers of HCV. Chronic HCV occurs in approximately 55-85% of patients. These patients will have positive anti-HCV antibodies and positive nucleic acid test (NAT) for HCV RNA, demonstrating the persistence of HCV and inability to appropriately clear the infection.[1][2]
![](/images/2/28/HCV_NH.png)
Prognosis
Acute HCV Infection[3]
- Clearance of HCV RNA: 15-45%
- Progression to chronic infection: 55-85%
- Fulminant Hepatitis: Rare
Chronic HCV Infection[3]
- Cirrhosis after 20 years: 10-20%
- Decompensated cirrhosis: 50% survival rate at 5 years
- Hepatocellular carcinoma: 1-4% per year
Complications
One major complications of chronic HCV infection are cirrhosis, which ultimately lead to a decompensated state, or transform into a malignant hepatocellular carcinoma (HCC).[4] Not all patients develop cirrhosis at the same rate; exposure to other risk factors of cirrhosis, such as alcohol, HBV or HIV infection, or immunocompromised states may hasten fibrosis of the liver and development of HCC.[5]
Chronic HCV eventually progresses to cause hepatic cirrhosis due to persistence of tissue inflammation and necrosis, along with fibrogenesis and deposition of components in the extracellular matrix. When left untreated, 15-30% of patients with chronic HCV develop cirrhosis within 20 years.[4]
Similarly, HCC is a known complication of chronic HCV infection. Patients with HCV develop HCC when the liver reaches its cirrhotic stage. The annual risk of HCC in patients with cirrhosis is about 2-4%.
Extrahepatic complications of HCV infection[6][4]:
- Cryoglobulinemia
- Membranoproliferative glomerulonephritis
- Autoimmune thyroiditis
- Sjogren syndrome
- Insulin resistance and type-2 diabetes mellitus
- Porphyria cutanea tarda
- Lichen Planus
- Hodgkin's lymphoma and non-Hodgkin's lymphoma
- Seronegative arthritis
- Cognitive dysfunction
- Depression
References
- ↑ Thomson EC, Fleming VM, Main J, Klenerman P, Weber J, Eliahoo J; et al. (2011). "Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men". Gut. 60 (6): 837–45. doi:10.1136/gut.2010.217166. PMC 3095479. PMID 21139063.
- ↑ Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Jung MC, Ulsenheimer A; et al. (2003). "Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance". Gastroenterology. 125 (1): 80–8. PMID 12851873.
- ↑ 3.0 3.1 Chen SL, Morgan TR (2006). "The natural history of hepatitis C virus (HCV) infection". Int J Med Sci. 3 (2): 47–52. PMC 1415841. PMID 16614742.
- ↑ 4.0 4.1 4.2 "Guidelines for the screening, care, and treatment of persons with HCV infection" (PDF). WHO. WHO. April 2014. Retrieved Jul 27 2014. Check date values in:
|accessdate=
(help) - ↑ Freeman AJ, Law MG, Kaldor JM, Dore GJ (2003). "Predicting progression to cirrhosis in chronic hepatitis C virus infection". J Viral Hepat. 10 (4): 285–93. PMID 12823595.
- ↑ Fletcher NF, McKeating JA (2012). "Hepatitis C virus and the brain". J Viral Hepat. 19 (5): 301–6. doi:10.1111/j.1365-2893.2012.01591.x. PMID 22497808.