Thomas D L, Astemborski J, Rai R M, Anania F A, Schaeffer M, Galai N, Nolt K, Nelson K E, Strathdee S A, Johnson L, Laeyendecker O, Boitnott J, Wilson L E, Vlahov D
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
JAMA. 2000 Jul 26;284(4):450-6. doi: 10.1001/jama.284.4.450.
Hepatitis C virus (HCV) infection may resolve (viral clearance), persist without complications, or cause end-stage liver disease (ESLD). The frequency and determinants of these outcomes are poorly understood.
To assess the incidence and determinants of viral clearance and ESLD among persons who acquired HCV infection from injection drug use.
Community-based prospective cohort study with enrollment in 1988-1989 and a median follow-up of 8.8 years.
A total of 1667 persons aged 17 years or older with a history of injection drug use and an HCV antibody-positive test result during follow-up.
Viral clearance was assessed in a subset of 919 patients and defined as failure to detect HCV RNA in at least 2 consecutive samples collected 5 or more months apart. End-stage liver disease was assessed at semiannual visits and by review of medical records and death certificates and defined by the presence of ascites, esophageal varices, or hepatic encephalopathy, or when ESLD was stated as a cause of death.
Viral clearance was observed in 90 persons who were compared with 722 with persistent viremia, while the viremia of 107 was not resolved. Viral clearance occurred more often in nonblacks (adjusted odds ratio [OR], 5.15; 95% confidence interval [CI], 2.60-10.17) and those not infected with human immunodeficiency virus (HIV) (adjusted OR, 2.19; 95% CI, 1.26-3.47). Forty cases of ESLD were observed throughout follow-up (incidence, 3.1 per 1000 person-years). In a multivariate model, risk of ESLD was higher for persons aged 38 years or older at enrollment (adjusted relative incidence, 3.67; 95% CI, 1.96-6.88) and who reported ingestion of more than 260 g of alcohol per week (adjusted relative incidence, 3.60; 95% CI, 1.73-7.52). Of 210 patients without ESLD randomly selected for biopsy, only 2 had cirrhosis.
Our results indicate that although HCV infection can be self-limited or associated with ESLD, the majority of adults have persistent viremia without clinically demonstrable liver disease. Further research is needed to explain the less frequent clearance of HCV infection among black persons and to improve utilization of treatment for those infected in the context of injection drug use. JAMA. 2000;284:450-456
丙型肝炎病毒（HCV）感染可能自行痊愈（病毒清除）、持续存在且无并发症，或导致终末期肝病（ESLD）。人们对这些结果的发生频率和决定因素了解甚少。
评估因注射吸毒而感染HCV的人群中病毒清除和ESLD的发生率及决定因素。
基于社区的前瞻性队列研究，于1988 - 1989年入组，中位随访时间为8.8年。
共有1667名17岁及以上有注射吸毒史且随访期间HCV抗体检测呈阳性的人。
在919例患者的亚组中评估病毒清除情况，定义为在间隔5个月或更长时间采集的至少2份连续样本中未检测到HCV RNA。每半年进行一次访视，并通过查阅病历和死亡证明来评估终末期肝病，其定义为存在腹水、食管静脉曲张或肝性脑病，或在死亡证明中将ESLD列为死因。
90人出现病毒清除，与之相比，722人持续存在病毒血症，107人的病毒血症未得到解决。病毒清除在非黑人中更常见（校正比值比[OR]，5.15；95%置信区间[CI]，2.60 - 10.17）以及未感染人类免疫缺陷病毒（HIV）的人中更常见（校正OR，2.19；95% CI，1.26 - 3.47）。在整个随访期间观察到40例ESLD（发病率为每1000人年3.1例）。在多变量模型中，入组时年龄在38岁及以上的人发生ESLD的风险更高（校正相对发病率，3.67；95% CI，1.96 - 6.88），以及每周饮酒超过260克的人（校正相对发病率，3.60；95% CI，1.73 - 7.52）。在随机选择进行活检的210例无ESLD的患者中，只有2例有肝硬化。
我们的结果表明，尽管HCV感染可能是自限性的或与ESLD相关，但大多数成年人存在持续病毒血症且无临床可证实的肝病。需要进一步研究来解释黑人中HCV感染清除较少见的原因，并改善对注射吸毒相关感染者的治疗利用情况。《美国医学会杂志》。2000年；284：450 - 456
