Clinical outcomes in a prospective study of community-acquired hepatitis C virus infection in Northern Norway

Objective. Knowledge on the natural course of the morbidity of unselected community-acquired hepatitis C virus (HCV) infection is limited. The aim of our study was to characterize the clinical outcomes of both hepatic and extrahepatic morbidity in patients infected with HCV in a community-based setting in Northern Norway. Material and methods. This prospective cohort study included 1010 HCV-positive patients diagnosed by recombinant immunoblot assay (RIBA), between 1 January 1990 and 1 January 2000. Questionnaires were sent to those physicians in Northern Norway who had requested the RIBA tests during the relevant period. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Access to confidential information was obtained from the Norwegian Directorate of Health. Results. Median age at follow-up was 39 and 41 years in females and males, respectively. In patients with positive HCV RNA status following results were found: Alanine aminotransferase was elevated in 27.4%, decompensated liver disease in 2.9% and hepatocellular carcinoma in 0.4%. Median observation period from estimated acquisition of the disease to follow-up in these patients was 26 years. Depression was reported in 10.7% of chronic infected subjects. Renal failure caused by membranoproliferative glomerulonephritis occurred in 0.2%. Conclusions. In an unselected HCV-RNA positive population severe liver disease developed in a sub-group of patients. These observations suggest that chronic HCV disease in relatively young subjects may cause a substantial burden on the health system in the future.