Natural History of Hepatitis C

Abstract

The natural history of infection with hepatitis C is incompletely understood, because the exact date of acquisition of infection is often unknown, many patients with hepatitis C escape detection, and current, widely used treatments may affect outcome. Seeff (1) proposed that the most accurate study to evaluate the natural history of hepatitis C should have five basic components. First, the date of onset of acute hepatitis C should be documented to properly determine duration of disease. Second, the study should include the full spectrum of acute disease, to avoid bias toward ascertainment of only the more severe forms of the disease. Third, the study should encompass the whole disease process, with complete follow-up to resolution of disease or clinical end points, regardless of the duration of disease must be examined. Fourth, the outcome of disease must be examined in the absence of treatment that could modify the course of the disease. Fifth, properly matched controls, followed with the same clinical intensity as patients with hepatitis C should be included. Another consideration is that studies of natural history should examine cohorts that are representative of the overall population with the infection. Unfortunately, no single study meets all of these criteria. Nonetheless, there are numerous studies of natural history and disease progression that shed light on the nature of this indolent, but highly significant chronic liver disease.