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.