guayoman
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Which of the following patients will have te lowest rate of progression of chronic hepatitis C to hepatic fibrosis and cirrhosis?
A. non-alcoholic female acquired HCV at 18
B. occasional alcoholic male acquired HCV at 44
C. non-alcoholic male with HBV and HCV
D. non-alcoholic female co infected with HIV and HCV
E. non-alcoholic male acquired HCV at 18
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| AAAAA
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B ?
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| AAAAA
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80-85% of all infected HCV will progress to chronic carriers
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| achilles
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A
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| AAAAA
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May be A
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| AAAAA
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Outcomes after chronic Hepatitis C (CHC)
The clinical course of chronic hepatitis C is generally
long and indolent and a fair number of patients remain
'stable' even when CHC has progressed to liver cirrhosis.
Roughly 50% of these patients are asymptomatic. A large
proportion of these patients are now coming to the fore
during routine testing of blood donors or have vague
complaints including right upper quadrant pain/discomfort
or malaise/fatiguability or on incidental detection of elevated
transminases.
Before discussing the results of large prospective and
retrospective studies of outcome of CHC, it is worth
addressing the issue of patients who are asymptomatic or
have persistently normal ALT. Alberti et al17 found nine out
of 16 patients with normal ALT and no symptoms to have
chronic hepatitis on biopsy. All these patients were HCV
RNA positive. Gholson et al.18 studied 50 patients with
persistently normal ALT. Although only a few were
symptomatic, abnormal histological features were seen in
46 (92%). While 60% of this study population had a grade
and/or stage of liver disease < 2, seven were cirrhotic (14%),
which underscores the point of stable but significant liver
disease mentioned above. At the other end of the spectrum
are studies which moot the concept of 'HCV carrier state.'
Naito et al.19 studied 22 HCV RNA positive subjects who
had persistently normal ALT for > 12 months. These workers
found a low probability of significant histological lesions,
despite the fact that 20 of the 22 patients had genotype Ib
(Table 3). However, with advancing age, there was a
tendency to more severe histological lesions, morisco et al.20
studied 27 anti-HCV-positive subjects for a mean of 2-6
years. The follow-up (bio-chemical) showed that the ALT
levels remained steady in these subjects. Of the 15 HCV
RNA positive subjects in this cohort, the mean ALT was
<0.6 times the upper limit of normal (ULN) while in the 12
RNA -negative subjects, it was <0.4 x ULN. The study
ALT levels cut across various viral loads and genotypes.
The main flaws in this study were, however, that all the
study subjects had no history of blood transfusion, IVDA
or alcohol consumption, i.e., the study population was a well
selected one. In addition, histological disease was assessed
in a small number of subjects only. A more important
message from this study is that the HCV RNA -positive
subjects continued to remain so at the end of follow-up.
Similar results were shown by Yokusuka et al.21, in a much
larger study population (n=320), followed up for more than
3 years. In their study of untreated patients, only 2% of the
cases became RNA negative at the end of follow-up, and
even in those who normalized ALT (3.5" ), the RNA levels
remained positive.
Vol. 8 No. 4, October - December 2001
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| AAAAA
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Progression to Chronic Liver Disease
Whereas past reports suggested that 50% of parenterally acquired and 5 to 15% of non-parenterally acquired HCV infections progressed to chronic liver disease, more recent studies employing sensitive assays for HCV indicate that about 80% of patients will remain infected with this virus beyond a 6 month period.5-6 Indeed, the possibility has been raised that chronic HCV infections may occur in all infected individuals.5 A reason(s) for the high propensity to develop a chronic carrier state in this disease remains to be determined. Viral mutations and spontaneous down regulation of viral replication may allow the virus to evade the host's immune responses. Alternatively, certain components of the immune response may be inadequate. For example, neutralizing antibodies in acute HCV tend to be weak and transient, and endogenous interferon production appears to be attenuated. Neither in the acute phase, nor thereafter, is viral RNA integrated into the host genome.
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| AAAAA
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Answer please
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| Jinx
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ill go with b
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| chemamr
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B or A
 . Please write the explanation master Guayoman.
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| guayoman
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The answer is A. Of the 5 choices the ones with less risk are non alcoholic teenagers. Of these, the male has more progression to cirrhosis.
So female, non alcoholic.
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| chemamr
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good 
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