HISTORY AND CLINICAL FEATURES OF CHRONIC HEPATITIS С: CHRONIC INFECTION
Hepatitis С virus infection becomes chronic in the majority of cases, manifested by the persistence of detectable virus in the serum. Chronic infection is usually characterized by a prolonged period in which there are no symptoms or only fatigue. No clinical features of acute disease or risk factors for infection have been found to be predictive of chronicity. Patients are often incidentally found to have elevated ALT levels on “routine” biochemical tests or a positive anti-HCV antibody result at the time of blood donation. Serum ALT levels typically fluctuate over time and may even be normal on occasion. The major complication of chronic HCV infection is progressive hepatic fibrosis leading to cirrhosis, which develops in approximately 15% to 20% of those infected with HCV.Progression of chronic liver disease is insidious in most patients. The average time from viral acquisition to the development of clinically significant hepatitis, cirrhosis, or hepatocellular carcinoma is 10 to 18 years, 21 years, and 29 years, respectively. Patients with persistently normal levels of serum ALT have a lower risk for fibrotic progression. However, a number of factors can accelerate progression to advanced liver disease, most notably alcohol consumption, co-infection with HIV or hepatitis В virus, and older age at the time of infection. In particular, excessive alcohol use has an additive effect on liver injury and can significantly promote the development of progressive liver disease. Even lower amounts may increase the risk of liver damage associated with HCV. Death from HCV typically occurs because of decompensated cirrhosis but may also be due to hepatocellular carcinoma.*80/348/5*
