Rate of natural disease progression in patients with chronic hepatitis C

Background/Aims: The interval at which liver biopsy should be repeated in untreated patients with chronic hepatitis C is not defined. We examined fibrosis change by METAVIR scoring in these patients in whom two or more liver biopsies were available. Methods: One hundred and eighty patients with histologically proven chronic hepatitis C were studied. Mean delay between biopsies was 3.67 ± 2.69 years and 3.08 ± 1.43 in the 16 patients having three biopsies. Univariate and multivariate analyses were performed to determine factors associated with liver fibrosis progression. Results: Median rate of fibrosis progression per year was 0.04 (0.00-0.55) to first biopsy, 0.00 (-0.84-1.02) between first and second biopsy (NS), and 0.17 (0.00-1.50) between second and third biopsy (P < 0.05). In multivariate analysis, only age at first biopsy >40 years (OR = 5) (2-12) and alcohol consumption of 1-50 g per day (OR = 4) (2-12) and more than 50 g per day (OR = 8) (3-23) were associated with severe fibrosis. The number of patients who increased in fibrosis stage was significantly higher after 4 years (P < 0.02). Conclusions: An interval of at least 4-5 years is needed between liver biopsies to measure change in patients with mild liver disease. Published by Elsevier Science B.V. on behalf of the European Association for the Study of the Liver.