Progression to Cirrhosis in Hepatitis C Patients: An Age-dependent Process
Posted 04/23/2007
See: http://www.medscape.com/viewarticle/554637_1
"......Our results are in agreement with the observation of Poynard et al.[11] showing that age at infection is directly associated with time to cirrhosis. In their study, the authors suggest that fibrosis progression is not linear but shows three phases characterized by little or no progression in the early phase, followed by moderate fibrosis progression in the second phase and finally by rapid fibrosis progression in the late phase of the disease Patients infected at younger age show a much slower rate of progression from phase 1 to phase 3, whereas patients infected at older ages show a much more rapid progression through these phases. Another prospective study has confirmed that fibrogenesis is not linear but that age is a highly significant risk factor for fibrosis progression in HCV infection, even more closely correlated to fibrosis progression than duration of infection.[17] Thus, there is supportive evidence that age matters considerably but the reason for it, however, remains unclear. As it was recently discussed, one possible explanation is the shortening of hepatocyte telomeres with increasing age[18] leading to hepatocyte senescence, loss of hepatocyte function, exhaustion of hepatocellular regeneration and to a greatly enhanced fibrotic response to injury......"
"Even if some factors have been shown to increase fibrosis progression,[26] the key question once a patient is infected by HCV is to estimate when cirrhosis will occur; in other words, how many years will be required before the patient becomes cirrhotic? No previous study has estimated the age at which cirrhosis is likely to occur. In our data, and apart from a particular patient profile (women infected by a non-1 genotype before 37 years of age), it is interesting to note a more or less uniform age at which cirrhosis is expected to occur (65 years). It should be kept in mind, however, that several factors such as heavy alcohol consumption or treatment can accelerate or delay fibrosis progression respectively."