Natural history of hepatitis C.
Open accessAbstract
There has long been evidence that hepatitis C can lead to persistent infection in a high proportion of infected individuals, and can progress to chronic liver disease, cirrhosis and hepatocellular carcinoma (HCC). The transition from acute to chronic hepatitis C is usually sub-clinical. Accurate studies of the time course for clearance of acute hepatitis C are difficult to carry out because of the silent onset of the acute disease. The likelihood of spontaneous HCV resolution is associated with several genetic factors, including IL28B inheritance and the DQB1*0301 allele of the major histocompatibility complex class II. Most data suggest that resolution in the acute phase without progression to chronic disease is not accompanied by significant disease, but minor histological lesions have been observed in anti-HCV positive, HCV RNA negative individuals. The risk of reinfection remains a possibility after clearance of acute hepatitis C. High rates of sexually-transmitted infection are being reported in HIV positive men who have sex with men (MSM). Chronic infection with HCV is the leading cause of end-stage liver disease, hepatocellular carcinoma (HCC) and liver related death in the Western world. The natural history of the chronic disease remains incompletely defined. It is generally a slowly progressive disease characterized by persistent hepatic inflammation, leading to the development of cirrhosis in approximately 10-20% of patients over 20-30 years of HCV infection. However, the published data indicate varying progression rates to cirrhosis. Overall, once cirrhosis has developed there is a 1-5% annual risk of HCC and a 3-6% annual risk of hepatic decompensation. Following an episode of decompensation the risk of death in the following year is between 15% and 20%. The high number of chronically infected individuals, the burden of disease, and the absence of a vaccine indicates that treatment will form part of the disease control but the impact, effectiveness and outcomes of treatment in various groups remain uncertain. Several studies and meta-analysis have concluded that eradication of HCV with antiviral therapy reduces the risk of HCC in patients with chronic hepatitis C, independent of fibrosis stage, but the risk is not eliminated.
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Transmission of HCV after receipt of blood from donors and from transplantation of tissues and organs with HCV infection has occurred only rarely since 1992, when routine screening of these donated products was mandated in the United States.
“Transmission after receipt of blood from donors and from transplantation of tissues and organs with HCV infection has occurred only rarely since 1992, when routine screening of these donated products was mandated in the United States (1367,1369).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1367]
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Experimental — accuracy not yet measured10%-20% of persons with chronic HCV infection develop cirrhosis in 20-30 years of active liver disease.
“10%–20% of persons with chronic infection develop cirrhosis in 20–30 years of active liver disease (1367).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1367]
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Taylor, L. E., Foont, J. A., DeLong, A. K., Wurcel, A. G., Linas, B. P., Chapman, S., Maynard, M. A., Cu‐Uvin, S., & Mayer, K. H. (2014) · AIDS Patient Care and STDs · doi:10.1089/apc.2013.0130 · Cited by 14 · see citing works
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Sexually Transmitted Infections Treatment Guidelines, 2021
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Jin, F., Matthews, G. V., & Grulich, A. E. (2017) · Sexual Health · doi:10.1071/sh16141 · Cited by 74 · see citing works
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Bajaj, J. S., Sterling, R. K., Betrapally, N. S., Nixon, D. E., Fuchs, M., Daita, K., Heuman, D. M., Sikaroodi, M., Hylemon, P. B., White, M. B., et al. (2016) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13732 · Cited by 63 · see citing works
- Authors
- Westbrook, R. H., & Dusheiko, G.
- Affiliations
- The Royal Free Hospital (GB)
- Corresponding author
- Dusheiko, Geoffrey
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 61
- Issue
- 1
- Pages
- S58-S68
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2147437748
- Cited by
- 1,049
- References
- 93
- Citations by year
- 2026: 30 · 2025: 37 · 2024: 48 · 2023: 80 · 2022: 96 · 2021: 101 · 2020: 95 · 2019: 123 · 2018: 104 · 2017: 107 · 2016: 85 · 2015: 67 · 2014: 38 · 2013: 33 · 2012: 3
- FWCI
- 12.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Keywords
- hepatitis C, natural history (disease), acute hepatitis C, chronic hepatitis C, HCV persistence, spontaneous clearance, IL28B, liver cirrhosis, hepatocellular carcinoma, hepatic decompensation, HCV reinfection, HIV-positive men who have sex with men, antiviral therapy, HCV eradication, liver fibrosis
- MeSH terms
- Antiviral Agents, Hepatitis C, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Risk Factors, Disease Progression
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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