The onset of chronic HCV infection early in life frequently leads to less serious consequences and more favorable outcomes. Studies have shown a significantly higher estimated probability of fibrosis progression in patients who were infected with HCV at an older age (> 40 years).
Male gender is among the established clinical risk factors for rapid progression of hepatic fibrosis. Other risk factors include older age, excessive alcohol use, high body mass index, and hepatitis B virus (HBV) or HIV co-infection.
Patients who acquire HCV infection via blood transfusion have double the risk for cirrhosis and HCC. In the past several decades, effective anti-HCV and HCV-RNA screening have sharply decreased the risk for transfusion-associated HCV infection in many countries, but older individuals may still have acquired HCV through blood transfusion.
Viral genotyping can be informative. The presence of hepatitis C genotype 3 — as opposed to genotype 1 or 2 — is associated with greater risk of developing steatosis, a faster rate of progression to cirrhosis, and increased risk of developing HCC. Studies have shown higher rates of hepatic steatosis, faster progression to cirrhosis, and higher rates of HCC among patients with genotype 3. Thus, close monitoring of disease progression in such patients is critical, and earlier consideration of HCV therapy for these genotypes may be warranted.
Learn more about the etiology and prognosis of HCV infection.
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