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November 22/29, 2000

Long-term Prognosis of Hepatitis C Virus Infection—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(20):2592. doi:10.1001/jama.284.20.2591

In Reply: In response to Dr Behrman, we followed up 1667 HCV-infected persons for a median of 8.8 years, and their estimated median duration of HCV infection was 13.7 years at enrollment. Data from some prior studies indicate that the infection duration profile of the cohort was ideal for detecting ESLD. For example, in 1 study 20% of persons with HCV infection following blood transfusion had cirrhosis 1.5 to 16 years later and 10% developed ESLD.1 On the other hand, our data and those recently reported by others indicate that the ESLD incidence can be much lower, underscoring the importance of factors that modify disease expression.2,3 Longer duration of infection, older age, and heavy alcohol use appear to be especially unfavorable prognostic factors.4 Thus, while it is difficult to predict the rate of disease progression for a given HCV-infected person, rates are best surmised from the experience of persons with similar risk profiles.