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45-Year Follow-up of Patients Infected with Hepatitis C as Young Adults
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What is the problem and what is known about it so far?
Infection of the liver with the hepatitis C virus can, in some cases, lead to severe liver disease. Little is known, however, about the outcome of hepatitis C infection over the long term. The drugs used to treat hepatitis C can cause side effects, are only partly effective, and are very expensive. Knowing how often serious liver disease actually results from hepatitis C infection would help in deciding whether widespread screening and treatment for hepatitis C is reasonable.
Why did the researchers do this particular study?
The researchers wanted to learn the long-term liver-related medical histories of patients who had become infected with hepatitis C virus when they were young adults.
Who was studied?
8568 military recruits at a Wyoming Air Force base who had had blood drawn between 1948 and 1954. The samples were kept frozen thereafter for almost 50 years.
How was the study done?
The researchers first tested the thawed blood samples for evidence of hepatitis C infection. Using computerized information from the Veterans Affairs Administration, the Health Care Financing Administration, and the National Death Index, they then tracked the medical condition of the recruits with and without hepatitis C infection between the time the initial blood samples were drawn and December 1996.
What did the researchers find?
Seventeen of the original blood samples from the 8568 recruits tested positive for hepatitis C infection. Over the 45 years of follow-up, 2 of these 17 recruits (11.8%) with hepatitis C developed liver disease compared with 205 of the 8551 (2.4%) without hepatitis C. Seven (41%) of the 17 recruits with hepatitis C had died by December 1996. One died of liver disease, 5 of causes other than liver disease, and 1 of an unknown cause. Of the 8551 recruits without infection, 2226 (26%) had died by this time, 119 from liver disease.
What were the limitations of the study?
The accuracy of the hepatitis C test results in blood stored this long is uncertain. It is also possible that some study subjects who were free of the infection at the time the blood was drawn developed it sometime during the next 45 years. With only 17 persons identified with infection, the study had limited ability to say definitely whether liver problems were more common in people with hepatitis C infection than in people without it.
What are the implications of the study?
Serious liver problems may not develop very frequently over the years as a result of hepatitis C infection acquired at a young age. Liver problems do, however, appear to be detectable more commonly over time in persons who have hepatitis C than in those who do not.
Article and Author Information
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The summary below is from the full report titled “45-Year Follow-up of Hepatitis C Virus Infection in Healthy Young Adults.” It is in the 18 January 1999 issue of Annals of Internal Medicine (volume 131, pages 105-111). The authors are L.B. Seeff, R.N. Miller, C.S. Rabkin, Z. Buskell-Bales, K.D. Straley-Eason, B.L. Smoak, L.D. Johnson, S.R. Lee, and E.L. Kaplan.
- Copyright ©2004 by the American College of Physicians
