Journal of Hepatology
Volume 51, Issue 4 , Pages 655-666, October 2009

Genotype 3 is associated with accelerated fibrosis progression in chronic hepatitis C☆

  • Pierre-Yves Bochud

      Affiliations

    • Department of Internal Medicine, Infectious Diseases Service, CHUV, Lausanne, Switzerland
    • Institute of Microbiology, University of Lausanne, CHUV, Lausanne, Switzerland
    • ,
  • Tao Cai

      Affiliations

    • Department of Internal Medicine, Infectious Diseases Service, CHUV, Lausanne, Switzerland
    • Institute of Microbiology, University of Lausanne, CHUV, Lausanne, Switzerland
    • ,
  • Kathrin Overbeck

      Affiliations

    • Division of Clinical Pathology, University Hospitals, Geneva, Switzerland
    • ,
  • Murielle Bochud

      Affiliations

    • Institute for Social and Preventive Medicine, CHUV, Lausanne, Switzerland
    • ,
  • Jean-François Dufour

      Affiliations

    • Division of Clinical Pharmacology, University Hospital, Bern, Switzerland
    • ,
  • Beat Müllhaupt

      Affiliations

    • Division of Gastroenterology and Hepatology, University Hospital of Zurich, Switzerland
    • ,
  • Jan Borovicka

      Affiliations

    • Division of Gastroenterology, Canton Hospital, St. Gallen, Switzerland
    • ,
  • Markus Heim

      Affiliations

    • Division of Gastroenterology and Hepatology, University Hospital of Basel, Switzerland
    • ,
  • Darius Moradpour

      Affiliations

    • Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
    • ,
  • Andreas Cerny

      Affiliations

    • Clinica Moncucco, Lugano, Switzerland
    • ,
  • Raffaele Malinverni

      Affiliations

    • Pourtalès Hospital, Neuchâtel, Switzerland
    • ,
  • Patrick Francioli

      Affiliations

    • Division of Hospital Preventive Medicine, CHUV, Lausanne, Switzerland
    • ,
  • Francesco Negro

      Affiliations

    • Division of Clinical Pathology, University Hospitals, Geneva, Switzerland
    • Division of Gastroenterology and Hepatology, University Hospitals of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva, Switzerland
    • Corresponding Author InformationCorresponding author. Tel.: +41 22 3729355; fax: +41 22 3729366.
    • ,
  • on behalf of the Swiss Hepatitis C Cohort Study Group

      Affiliations

    • The members of the Swiss Hepatitis C Cohort Study Group are listed in the Appendix.

Received 8 February 2009; received in revised form 9 April 2009; accepted 5 May 2009. published online 08 June 2009.

Associate Editor: J.G. McHutchison

Background/Aims

While several risk factors for the histological progression of chronic hepatitis C have been identified, the contribution of HCV genotypes to liver fibrosis evolution remains controversial. The aim of this study was to assess independent predictors for fibrosis progression.

Methods

We identified 1189 patients from the Swiss Hepatitis C Cohort database with at least one biopsy prior to antiviral treatment and assessable date of infection. Stage-constant fibrosis progression rate was assessed using the ratio of fibrosis Metavir score to duration of infection. Stage-specific fibrosis progression rates were obtained using a Markov model. Risk factors were assessed by univariate and multivariate regression models.

Results

Independent risk factors for accelerated stage-constant fibrosis progression (>0.083 fibrosis units / year) included male sex (OR=1.60, [95% CI 1.21–2.12], P<0.001), age at infection (OR=1.08, [1.06–1.09], P<0.001), histological activity (OR=2.03, [1.54–2.68], P<0.001) and genotype 3 (OR=1.89, [1.37–2.61], P<0.001). Slower progression rates were observed in patients infected by blood transfusion (P=0.02) and invasive procedures or needle stick (P=0.03), compared to those infected by intravenous drug use. Maximum likelihood estimates (95% CI) of stage-specific progression rates (fibrosis units / year) for genotype 3 versus the other genotypes were: F0→F1: 0.126 (0.106–0.145) versus 0.091 (0.083–0.100), F1→F2: 0.099 (0.080–0.117) versus 0.065 (0.058–0.073), F2→F3: 0.077 (0.058–0.096) versus 0.068 (0.057–0.080) and F3→F4: 0.171 (0.106–0.236) versus 0.112 (0.083–0.142, overall P<0.001).

Conclusions

This study shows a significant association of genotype 3 with accelerated fibrosis using both stage-constant and stage-specific estimates of fibrosis progression rates. This observation may have important consequences for the management of patients infected with this genotype.

Keywords: Hepatitis C, Fibrosis, Steatosis, Inflammation, Epidemiology

Abbreviations: HCV, hepatitis C virus, SCCS, Swiss Hepatitis C Cohort Study, BMI, body mass index, HIV, human immunodeficiency virus, ALT, alanine aminotransferase

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☆ The authors who have taken part in this study declared that they do not have anything to disclose regarding funding from industry or conflict of interest with respect to this manuscript.

PII: S0168-8278(09)00386-9

doi:10.1016/j.jhep.2009.05.016

Refers to article:

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    Stefan Zeuzem
    Journal of Hepatology October 2009 (Vol. 51, Issue 4, Pages 626-627)

Journal of Hepatology
Volume 51, Issue 4 , Pages 655-666, October 2009

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