The Prevalence of Intrinsic Host Risk Factors Associated with Progressive Disease in Patients with Chronic Hepatitis C Viral Infections

Article excerpt

ABSTRACT

The prevalences of three risk factors that have been identified as important predictors of more progressive forms of chronic hepatitis C viral (HCV infections (male gender, transfusion recipients and age greater than 50 years at the onset of infection) were documented by a retrospective chart review of 337 HCV-infected patients attending an urban, hospital-based, viral hepatitis clinic. One hundred and ninetyfive patients (58%) were male. One hundred and eighteen (35%) had received blood or blood product transfusions in the past, 33% of whom also gave a history of intravenous drug use. Approximately 5%io of patients were over the age of 50 years at the estimated time of infection. Twenty percent of patients had two and 4% had all three risk factors. In conclusion, intrinsic host risk factors associated with progressive HCV infection were common in this patient population. If confirmed in other centres, these results suggest that the medical and financial demand on the health care system is likely to be appreciable unless effective and safe therapies for HCV are identified and implemented in the near future.

ABREGE

La prevalence de trois facteurs de risque identifies comme d'importants predicteurs de formes plus progressives d'infection chronique par le virus de fheparite C (VHC) (sexe masculin, transfuse et plus de 50 ans a l'apparition de (infection) a ete documente a l'aide d'un examen retrospectif des dossiers medicaux de 337 patients infectes par ie VHC qui ont fait appel aux services dune consultation externe pour l'hepatite virale, situee daps un hopital urbain. Cent quatre-vingt quinze patients (58 %) etaient de sexe masculin. Cent dix-huit (35 %) avaient eu par le passe une transfusion de sang ou de produit du sang, 33% d'entre eux ayant aussi des antecedents d'usage de drogues injectables. Environ 5% des patients etaient ages de plus de 50 ans au moment presume de (infection. Vingt pour cent des patients avaient deux des trois facteurs, et 4% avaient les trois. En conclusion, les facteurs de risque intrinseques chez l'hote factuers, a une infection progressive par le VHC sont apparus courants au rein de ce segment de la population. S'ils sont confirmes par d'autres centres, ces resultats indiqueront que les demandes financieres et medicales qui vont etre faites au systeme de soins de same risquent d'etre importantes, a moms que des therapies anti-VHC efficaces et sans danger soient decouvertes et mises en oeuvre dans un avenir proche.

Certain intrinsic host factors have been identified as being associated with more progressive chronic hepatitis C viral (HCV) infections.1 These factors include male gender, acquisition of HCV by blood or blood product transfusions, and age >50 years at the time of infection.2,3 What percent of the current HCV patient population possess one, two or all of these risk factors has yet to be reported. In addition to patient counselling, such information is also important in predicting the health care needs of HCV patients and the financial burden those needs will place on the health care system. Thus, the purpose of the present study was to document the prevalence of these host factors in HCV patients attending an urban, outpatient viral hepatitis clinic.

Because various governments and health care providers are contemplating whether to offer compensation to patients who may have acquired their HCV infections from blood or blood product transfusions during the 1986-90 period when surrogate screening of blood donors for HCV was available but not employed, we also endeavored to determine what percent of the total HCV population these individuals constituted and what percent had blood or blood product transfusions as their sole risk factor for viral acquisition.

MATERIALS AND METHODS

Study population

The charts of 398 patients seen at the Liver Diseases Unit, Health Sciences Centre, Winnipeg, Manitoba between January 1, 1991 and January 1, 1998 with a diagnosis of HCV infection were retrospectively reviewed for: 1) accuracy of diagnosis, and 2) the patients' responses to a questionnaire posed by a physician during one-on-one interviews at the initial evaluation visit. …