Hepatitis C in chronic liver disease: an epidemiological study based on 566 consecutive patients undergoing liver biopsy during a 10‐year period

Abstract

We analysed the presence of hepatitis C virus (HCV) antibodies in 566 patients undergoing liver biopsy. While over 20% of the patients were anti‐HCV positive according to elisa, only 13.8% had HCV antibodies when tested with a four‐antigen recombinant immunoblot assay (RIBA 2). At the time of inclusion in the study, most patients were asymptomatic, irrespective of whether they were HCV‐positive. Histological findings in anti‐HCV‐positive patients were chronic persistent hepatitis, chronic active hepatitis or cirrhosis in > 75% of cases. Only four of the patients who were anti‐HCV‐positive according to the RIBA 2 had autoimmune chronic active hepatitis. Risk behaviour could be identified in the majority of cases. Community‐acquired sporadic cases were rare (12%). Of the 153 patients who died during follow‐up, 23 subjects were anti‐HCV positive. Although age‐ and sex‐adjusted survival was not shorter in anti‐HCV‐positive patients than in anti‐HCV‐negatives, the risk of hepatocellular cancer was higher (P = 0.01). We conclude that HCV infection is associated with chronic liver disease, even when critical evidence of viral aetiology is slight. Truly sporadic cases are rare. Patients infected with HCV are at increased risk of developing hepatocellular cancer.