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| |  DG DISPATCH - GASTRO99: Studies Uncover Major Variations In How Hepatitis C Progresses By Cameron Johnston Special to DG News VANCOUVER, BC -- Sept. 1, 1999 -- How a person acquires the hepatitis C virus makes a significant difference to the disease’s progression, researchers reported yesterday at Gastro 99 - the Pan American congress of Digestive Diseases conference being held in Vancouver, B.C. Researchers from Canada and France say that whether the person contracts the deadly virus from blood transfusions, intravenous drug use, needle stick injuries (in the case of healthcare workers) or from organ transplants will have a profound impact on whether they develop a more virulent form of the disease. This will ultimately affect whether they suffer total liver failure and perhaps develop liver cancer. Dr. Mang Ma, assistant professor of gastroenterology at the University of Alberta and a member of the International Hepatitis Interventional Therapy Group, said that depending on whether the patient acquired the disease through a blood transfusion or through intravenous drug use, there were significant differences in the percentage of patients developed cirrhosis of the liver. For those who had the disease less than five years, 18 percent of blood transfusion patients had cirrhosis of the liver, indicating total liver failure, whereas less than two percent of drug users did. For blood transfusion recipients who had the virus for between 5-9 years, one-quarter had cirrhosis of the liver as compared with just six percent of drug users. Dr. Ma said that part of this discrepancy might be explained by the fact that those who had received blood transfusions were also 20 years older, on average, than the drug users. Nonetheless, he said the difference in natural history of the disease was remarkable. All of this compares with the incidence of liver failure in a group of Irish women who all contracted the disease through a tainted immunoglobulin preparation and in whom only four percent had severe inflammation and two percent had cirrhosis after 17 years of infection. The difference in the severity of the disease may even extend to non-intravenous drug use. Those who have used cocaine more than 10 times will develop this disease faster and in a more severe form than those who use cocaine less than 10 times, or never. Meanwhile, Dr. Thierry Poynard, a professor of medicine at l’Hopital Pitie Salpetriere, Paris, said HCV represents a “menage-a-trois” between the host, the virus and the fibrosis that develops from the disease. The various stages of fibrotic development in the liver are rated on a scale from F0 to F4, leading to liver hemorrhage, hepatic insufficiency and ultimately cancer of the liver. “Fibrosis is predictive for the outcome of liver failure in people with HCV in the same way that a CD-4 count is for people with HIV,” Dr. Poynard explained. The most important factors that predict how long a person with HCV will survive, or how quickly their liver will deteriorate, are their age (People who contract the virus over the age of 30 will develop fibrosis and cirrhosis 27 times faster than those who are under 30); alcohol consumption (drinking more than 200 ml per day is associated with greater risk); and their gender (since women with HCV experience a more benign form of the disease due to the protective benefit from estrogen). The researchers disagreed as to the role viral load played in disease progress. Dr. Ma said the viral load was dependent on the mode of transmission, so those who had needle-stick injuries or those who used intravenous drugs less than 10 times would not have as high a viral load as those who had had blood transfusions and organ transplants. Dr. Poynard disagreed, saying that neither the viral load nor the genotype of the virus appear to have a bearing on how quickly they progress to fibrosis.
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