Hepatitis activity index is a key factor in determining the natural history of chronic hepatitis C

Hum Pathol. 2001 Sep;32(9):904-9. doi: 10.1053/hupa.2001.28228.


To analyze the spontaneous pathologic progression of chronic hepatitis C, we analyzed the histopathologic semiquantitative scores (Metavir and Knodell) of sequential liver biopsies performed in untreated hepatitis C virus (HCV)-infected patients. Subjects included 35 men and 41 women, with a mean age of 41 +/- 12 years, a duration of HCV infection of 11 +/- 5 years, and an interval between liver biopsies of 3.7 +/- 2.5 years. Results obtained using the Knodell score and the Metavir score were similar. At the first biopsy, 78.9% of patients had a low activity score (A0-A1) and 82.9% had a low fibrosis score (F0-F2). At the second biopsy, the activity decreased in 9.2%, was unchanged in 72.4%, and increased in 18.5%. An increase in activity was more frequently observed in patients infected with genotype 1 (28.9%) than with others (7.7%; P =.04); the yearly progression of activity was significantly higher in patients with a low rather than high initial activity score (0.11 v -0.02; P <.01). An increase in fibrosis was noted in 13.3% of those with a low and 43.8% of those with a high initial activity score (P <.01), with a highest rate of yearly fibrosis progression (0.12 U). In multivariate analysis, only a high activity score was significantly associated with an increased risk of fibrosis progression (relative risk, 25.5; 95% confidence interval, 2.7 to 238; P =.004). Spontaneous chronic hepatitis C evolution is worsening in only 20% of patients. Fibrosis progression is significantly associated with the necroinflammatory activity suggesting that this factor should be regarded as a major clue for deciding therapy.

MeSH terms

  • Adult
  • Alanine Transaminase / blood
  • Antibodies, Viral / analysis
  • Biopsy
  • Disease Progression
  • Female
  • Hepacivirus / classification
  • Hepacivirus / genetics
  • Hepacivirus / immunology
  • Hepacivirus / isolation & purification
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / diagnosis*
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis / pathology
  • Male
  • RNA, Viral / analysis


  • Antibodies, Viral
  • RNA, Viral
  • Alanine Transaminase