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World J Gastroenterol. Jun 28, 2008; 14(24): 3861-3865
Published online Jun 28, 2008. doi: 10.3748/wjg.14.3861
Pathological evolution of hepatitis C virus-“Healthy carriers”
Rodolphe Sobesky, Pascal Lebray, Bertrand Nalpas, Anaïs Vallet-Pichard, Hélène Fontaine, Jean-Luc Lagneau, Stanislas Pol
Rodolphe Sobesky, INSERM U785, Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif 94807, France
Rodolphe Sobesky, Pascal Lebray, Bertrand Nalpas, Anaïs Vallet-Pichard, Hélène Fontaine, Jean-Luc Lagneau, Stanislas Pol, United Hepatologie, Hopital Cochin, Universite Paris V-Rene Descartes, Paris 75014, France
Author contributions: Sobesky R and Pol S designed research; Sobesky R, Lebray P, Vallet-Pichard A, Fontaine H and Lagnau JL performed research; Nalpas B and Pol S performed statistical analysis; Sobesky R and Pol S wrote the paper.
Correspondence to: Rodolphe Sobesky, INSERM U785, Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif 94807, France. rodolphe.sobesky@pbr.aphp.fr
Telephone: +33-1-45596084
Fax: +33-1-45596080
Received: January 3, 2008
Revised: April 7, 2008
Accepted: April 14, 2008
Published online: June 28, 2008
Abstract

AIM: To determine factors associated with fibrosis progression in hepatitis C virus (HCV)-infected patients without significant initial pathological lesions.

METHODS: Seventy six untreated HCV-infected patients with initially normal liver as defined by a Knodell score ≤ 3, with 2 liver biopsies and detectable HCV-RNA were included. Markers of fibrosis progression were assessed.

RESULTS: Median duration of infection and time between paired biopsies was 13 (95% CI: 1-28) and 4 (95% CI: 2-16) years respectively. Alanine-transaminase (ALT) activity was normal in 43.4% of cases. 50% demonstrated progression of the necro-inflammation and 34% of fibrosis after a median time evolution of 4 years (95% CI: 2-16). The median difference in the necro-inflammation and fibrosis score between biopsies was low, 1.5 and 0.0 respectively. Univariate analysis showed there was no difference between fibrosis activity or evolution according to genotype or viral load. A higher fibrosis progression (P = 0.03) was observed in patients with body mass index (BMI) > 25. Fibrosis progression correlated with the time interval between biopsies (P = 0.01). A significant progression of activity (1.7 vs 0.4, P < 0.05) or fibrosis (0.9 vs 0.0, P < 0.01) was observed in patients with elevated ALT. There was a significant correlation between activity progression and fibrosis progression (P = 0.003). Multivariate analysis demonstrated that fibrosis progression was associated with elevated ALT, BMI > 25 and the time interval between 2 biopsies.

CONCLUSION: There is no fibrosis progression in 66% of patients without significant initial histopathological lesion. Fibrosis progression is associated with elevated ALT and BMI > 25.

Keywords: Hepatitis C virus, Liver fibrosis, Liver biopsy, Alanine-transaminase, Body mass index