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Slide 3 – Disease progression in hepatitis C: person-to-person variability The course of HCV infection varies widely between individuals. Various factors influence the rate of progression. Female sex and young age at the time of infection are factors that decrease the risk of disease progression. In contrast, alcohol use and co-infection with HIV or hepatitis B virus increase the risk of disease progression.1 An acute symptomatic phase of liver inflammation may occur 15-50 days after infection, but 60-70% of cases are asymptomatic. Approximately 80% of patients with acute HCV develop chronic infection; however, some patients clear HCV spontaneously. Cirrhosis develops in up to 20% of patients with chronic hepatitis C over 20-30 years.2 Once cirrhosis is established, complications such as jaundice, ascites, variceal haemorrhage and encephalopathy can develop. These complications mark the transition from compensated to decompensated liver disease. Most cases of hepatocellular carcinoma (HCC) occur in the presence of cirrhosis, at a rate of 1-4% per year. After the development of cirrhosis, a high proportion of patients survive for 10 years or more. However, once decompensation begins, survival rates drop dramatically. HCC = hepatocellular carcinoma; HCV = hepatitis C virus; HIV = human immunodeficiency virus References: 1. Lauer Walker. N Engl J Med 2001; 345:41–52 2. Centers for Disease Control and Prevention. MMWR 1998; 47:No. RR-19 Slide updated in March 2005. Further information available at: /home/home.cfm Slide 20 – Effect of HIV on progression to cirrhosis in HCV co-infection: pre-HAART era Numerous studies have shown that liver disease associated with hepatitis C virus (HCV) infection is accelerated in patients infected with HIV. This means that patients with both viruses progress to cirrhosis and liver cancer much more quickly than if they were infected with HCV alone. Soto et al. conducted a study of 547 people with HCV infection, 116 of whom also