The natural history of hepatitis C with severe hepatic fibrosis

Background/Aims To examine the morbidity and mortality of patients with severe fibrosis secondary to HCV infection, within a population unbiased by tertiary referral. Methods One hundred and fifty HCV infected patients were identified from the Trent HCV study with a liver biopsy taken before 2002 demonstrating severe fibrosis (Ishak stage 4). Follow-up data were extracted from the database and hospital records. Results Median follow-up was 51 months. Of the 131 patients with no prior history of decompensation, 33 (25%) died (n = 25) or were transplanted (n = 8), after a median interval of 42 months. The probability of survival without liver transplantation was 97%, 88%, and 78% at 1, 3, and 5 years, respectively. Hepatocellular carcinoma and/or decompensation was diagnosed in 33 (25%), after a median interval of 41 months. In multivariate analysis, combination antiviral therapy was associated with improved survival. Prognosis was not affected by the Ishak stage at index biopsy. There was a worse prognosis for the 19 patients with previous decompensation; 17 (89%) having either died (n = 15) or been transplanted (n = 2). Conclusions This study demonstrates that severe liver fibrosis (Ishak stage 4) secondary to hepatitis C is associated with a poor prognosis, that may be improved following combination antiviral treatment.