RE: This article was on that page

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Highlighting

is mine. 30% progressing to life-threatening liver disease may not be a

majority, but it ain’t no small percentage either. On to the next

article…..

Semin

Liver Dis. 2000 ;20 (1):17-35 10895429 [Cited: 32]

Recovery, persistence,

and sequelae in hepatitis C virus infection: a perspective on long-term

outcome.

[My paper] H J Alter , L B Seeff

Hepatitis C has emerged in recent years

as the most common basis for liver disease in the United

States, having infected an estimated 3.9

million people in this country and an estimated 170 million worldwide. Currently, it is the predominant reason for

undergoing liver transplantation. The disease it causes is characterized by

silent onset in most infected individuals, a high rate of viral persistence,

and the potential for development of ever-worsening chronic liver disease,

ranging from chronic hepatitis to cirrhosis and occasionally to hepatocellular

carcinoma. Such progression, when it occurs, is also most commonly a silent

process that may take 20-40, and occasionally even more, years to reach its

end point. Because of these characteristics, it has been exceedingly

difficult to accurately assess the natural history. Efforts to accomplish

this have consisted of retrospective, prospective, and cohort studies. The

most concerning data have derived from the retrospective study approach,

generally performed at tertiary referral centers. Because these centers

commonly attract persons with existing chronic liver disease, they have

tended to describe a high rate of progression to cirrhosis and cancer. This

" referral bias " is avoided in the prospective and cohort study

approach, and data derived from these studies indicate a lower rate of

progression and a correspondingly higher rate of either recovery or minimal

liver disease. In this review, we briefly describe potential mechanisms of

viral persistence; present detailed information on outcomes that have derived

from retrospective, prospective, and cohort studies, involving both adults

and children; examine the data regarding progression of fibrosis and of

progression to hepatocellular carcinoma; consider cofactors that might enhance

liver disease progression; and report the emerging data that suggest that

spontaneous viral clearance may be higher than is currently believed. We conclude with the view that severe,

life-threatening, progressive liver disease clearly occurs in a sizable

minority (perhaps 30%) of chronically infected persons but speculate that

fibrosis progression is neither linear or inevitable and hence that most

hepatitis C virus carriers will have either a stable nonprogressive course or

such indolent progression that they will die from an unrelated disease before

the severe sequelae of hepatitis C become manifest or will have a sustained

" curative " response to therapy. Although this view provides

reasonable hope to the hepatitis C virus-infected individual, it does not

deny the enormous burden this infection presents as the result of its high

prevalence and global distribution. The sheer

magnitude of the infected population will result in a large number with

severe life-threatening liver disease even if the proportion of infected

individuals that develop progressive disease is relatively small.

Mesh-terms:

Acute Disease;

Adolescent;

Adult;

Child;

Child, Preschool;

Disease Progression;

Female;

Hepacivirus,

isolation & purification; Hepatitis C,

Chronic, complications; Hepatitis C,

Chronic, diagnosis; Hepatitis C,

Chronic, mortality; Hepatitis C,

complications; Hepatitis C,

diagnosis; Hepatitis C,

mortality; Human; Incidence;

Liver Cirrhosis,

epidemiology; Liver Cirrhosis,

etiology; Liver Cirrhosis, physiopathology;

Liver Neoplasms,

epidemiology; Liver Neoplasms,

etiology; Liver Neoplasms, physiopathology;

Male;

Middle Aged;

Prognosis;

Risk Factors;

Survival Rate;

United States,

epidemiology; World Health

Organization;

Re: why treat

>

> The studies I've read say 15% clear on their own, and that's in the

first 3

> months of acute infection. Can you send us that study that says 24%

please?

Hopefully this will help

http://lib.bioinfo.pl/meid:194759

I misquoted it was 23%

Rambo Roy