By Dr. Helen Harris

Hepatitis C virus (HCV) is a common cause of liver disease1 and a major health problem worldwide. Acute infection is rarely diagnosed, and information about the clinical course of HCV infection has come largely from retrospective studies of patients with established liver disease.

Such studies exclude people with no clinical evidence of infection, and observations are often biased towards severe disease outcomes.

Hepatitis C virus infection did not have a great impact on death rates in the first decade of infection.

The clinical course of HCV infection is unclear because most information has come from studies of patients with established chronic liver disease
However, infected patients have an increased risk of dying from a liver related cause, particularly if they consumed excess alcohol.

The study provided data on a group of patients infected with HCV for which the time since infection is accurately known. The average time from obtaining the virus to cirrhosis has been estimated to be 30 years, and so the death rate described here occurred after a relatively short observation period.

Overall, patients who have been infected for longer tend to be more sick than patients who have been infected more recently. Some patients, however, progress rapidly to end stage liver disease, whereas others remain unaffected.

This is likely to be due to individual effects (like genetic differences), as well as other risk factors such as sex, age, and alcohol intake. Male sex is independently associated with an increased risk of progressive disease, and this might explain the relatively low rate of disease seen in females.