Natural History

in most individuals with chronic HC infection there will be biochemical and histological evidence of chronic hepatitis, in addition to circulating HCV ribonucleic acid (RNA). Among the 14 to 46% of acutely infected patients who recover, many will retain HCV antibodies for several years, whereas others will have no serologic markers of HCV infection on extended observation. In a smaller group (approximately 27%), viremia is persistent (or possibly intermittent) but serum alanine aminotransferase (ALT) levels are usually normal.

Reported rates of spontaneous clearance in acute infections have ranged from 14 to 46%. Both viral and host factors have been linked to viral persistence. The natural history of chronic HCV infection has been estimated both from prospective studies beginning with acute infection following blood transfusion, and from prospective obser vation of patients diagnosed with chronic HCV infection. Once chronic HCV infection has been established, there appears to be an overall risk of cirrhosis as high as 20% over the first 10 to 20 years of infection. Indeed, in the United States, the incidence of hepatocellular carcinoma (HCC) is increasing and deaths from cirrhosis secondary to chronic HCV infection are estimated to be 8,000 to 12,000 per year and are rising steadily.

Host factors that are strongly implicated in progression of chronic HC infection include older age at infection, male gender, and concomitant alcohol use. Additional factors that have been suggested include hepatic steatosis, iron loading, and human immunodeficiency virus (HIV) coinfection. In one study, cirrhosis was present in 43% of patients older than 50 years of age at the time of infection compared with 6% of those infected when younger than 20 years of age. Similarly, a prospective study from Ireland of young women infected with HCV from contaminated blood products demonstrated only a 1 to 2% rate of cirrhosis after nearly 20 years.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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