The natural history of hepatitis C virus infection - Host, viral, and environmental factors
The natural history of hepatitis C virus infection - Host, viral, and environmental factors
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DOI：
10.1001/jama.284.4.450
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发表时间：
2000-07-26
影响因子：
120.7
通讯作者：
Vlahov, D
中科院分区：
文献类型：
--
作者：
Thomas, DL;Astemborski, J;Vlahov, D
丙型肝炎病毒（HCV）感染可能会消退（病毒清除），持续无并发症，或导致终末期肝病（ESLD），这些结果的频率和决定因素知之甚少。目的评估注射吸毒获得HCV感染者中病毒清除和终末期肝病的发生率和决定因素。设计和设置以社区为基础的前瞻性队列研究，1988年至2002年招募，1989年和平均随访时间为8.8 years.Subjects A total of 1667人年龄在17岁或以上的注射吸毒史和HCV抗体阳性的测试结果在follow-up.Main结果测量病毒清除率进行了评估，在一个子集的919例患者，并定义为未能检测到HCV RNA在至少2个连续的样本收集5个月或更长的时间间隔。终末期肝病进行了评估，在半年一次的访问和审查的医疗记录和死亡证明，并定义的腹水，食管静脉曲张，或肝性脑病的存在下，或当ESLD被列为死因。结果观察到病毒清除90人相比，722与持续性病毒血症，而病毒血症的107没有得到解决。非黑人（校正比值比[OR]，5.15; 95%置信区间[CI]，2.60-10.17）和未感染人类免疫缺陷病毒（HIV）的人群（校正比值比，2.19; 95% CI，1.26-3.47）的病毒清除率更高。在整个随访期间观察到40例ESLD（发生率为3.1/1000人-年）。在多变量模型中，入组时年龄在38岁或以上（校正的相对发病率，3.67; 95%CI，1.96-6.88）和报告每周摄入超过260 g酒精（校正的相对发病率，3.60; 95%CI，1.73-7.52）的人的ESLD风险较高。210例无ESLD随机选择活检，只有2有cirrhosis.Conclusions我们的研究结果表明，虽然HCV感染可以自限性或与ESLD，大多数成年人有持续的病毒血症，没有临床可证实的肝脏疾病。需要进一步的研究来解释黑人中HCV感染的清除率较低的原因，并提高注射毒品感染者的治疗利用率。
Context Hepatitis C virus (HCV) infection may resolve (viral clearance), persist without complications, or cause end-stage liver disease (ESLD), The frequency and determinants of these outcomes are poorly understood.Objective To assess the incidence and determinants of viral clearance and ESLD among persons who acquired HCV infection from injection drug use.Design and Setting Community-based prospective cohort study with enrollment in 1988-1989 and a median follow-up of 8.8 years.Subjects A total of 1667 persons aged 17 years or older with a history of injection drug use and an HCV antibody-positive test result during follow-up.Main outcome Measures Viral clearance was assessed in a subset of 919 patients and defined as failure to detect HCV RNA in at least 2 consecutive samples collected 5 or more months apart. End-stage liver disease was assessed at semiannual visits and by review of medical records and death certificates and defined by the presence of ascites, esophageal varices, or hepatic encephalopathy, or when ESLD was stated as a cause of death.Results Viral clearance was observed in 90 persons who were compared with 722 with persistent viremia, while the viremia of 107 was not resolved. Viral clearance occurred more often in nonblacks (adjusted odds ratio [OR], 5.15; 95% confidence interval [CI], 2.60-10.17) and those not infected with human immunodeficiency virus (HIV) (adjusted OR, 2.19; 95% CI, 1.26-3.47). Forty cases of ESLD were observed throughout follow-up (incidence, 3.1 per 1000 person-years). In a multivariate model, risk of ESLD was higher for persons aged 38 years or older at enrollment (adjusted relative incidence, 3.67; 95% CI, 1.96-6.88) and who reported ingestion of more than 260 g of alcohol per week (adjusted relative incidence, 3.60; 95% CI, 1.73-7.52). Of 210 patients without ESLD randomly selected for biopsy, only 2 had cirrhosis.Conclusions Our results indicate that although HCV infection can be self-limited or associated with ESLD, the majority of adults have persistent viremia without clinically demonstrable liver disease. Further research is needed to explain the less frequent clearance of HCV infection among black persons and to improve utilization of treatment for those infected in the context of injection drug use.