{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:55:33Z","timestamp":1791428133737,"version":"4.3.3"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2017,5,22]],"date-time":"2017-05-22T00:00:00Z","timestamp":1495411200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1"},{"start":{"date-parts":[[2017,5,22]],"date-time":"2017-05-22T00:00:00Z","timestamp":1495411200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>Long\u2010term prospective studies of the outcomes associated with hepatitis C virus (HCV) infection are rare and critical for assessing the potential impact of HCV treatment. Using liver biopsy as a starting point, we analyzed the development of end\u2010stage liver disease (ESLD), hepatocellular carcinoma (HCC), and liver\u2010related death (LRD) according to fibrosis stage among a cohort of American Indian\/Alaska Native persons in Alaska. Persons were classified as having no\/mild (Ishak = 0,1), moderate (Ishak = 2), or severe (Ishak = 3,4) fibrosis or cirrhosis (Ishak = 5,6). We examined time until development of ESLD, HCC, and LRD and report survival probabilities at 3, 5, 7, and 10 years. Of 407 persons, 39% (n = 150) had no\/mild fibrosis, 32% (n = 131) had moderate fibrosis, 22% (n = 88) had severe fibrosis, and 9% (n = 38) had cirrhosis. The average time of follow\u2010up was 7.3 years. Within 5 years of biopsy, 1.7% (95% confidence interval [CI]: 0.4\u20106.8) of persons with no\/mild fibrosis developed ESLD compared with 7.9% (95% CI, 4.0\u201015.2), 16.4% (95% CI, 9.6\u201027.2), and 49.0% (95% CI, 33.0\u201067.7) with moderate, severe fibrosis, and cirrhosis, respectively (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). The 5\u2010year outcome of HCC was 1.0% (95% CI, 0.1\u20107.0), 1.0% (95% CI, 0.1\u20106.6), 1.1% (95% CI, 0.2\u20107.7), and 13.4% (95% CI, 4.4\u201036.7) among persons with no\/mild fibrosis, moderate fibrosis, severe fibrosis, and cirrhosis, respectively (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). Five years after biopsy, 0.0% (95% CI, 0.0\u201014.8) of persons with no\/mild fibrosis had suffered an LRD compared with 1.0% (95% CI, 0.2\u20107.5) of persons with moderate fibrosis, 4.7% (95% CI, 1.5\u201014.1) with severe fibrosis, and 16.3% (95% CI, 7.0\u201035.1) with cirrhosis (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.01). <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: For prevention of HCC, LRD, and ESLD in the short term, HCV therapy should target individuals who have more than mild fibrosis. (H<jats:sc>epatology<\/jats:sc> 2017;66:37\u201345).<\/jats:p>","DOI":"10.1002\/hep.29115","type":"journal-article","created":{"date-parts":[[2017,2,13]],"date-time":"2017-02-13T12:28:53Z","timestamp":1486988933000},"page":"37-45","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":45,"title":["Risk of end\u2010stage liver disease, hepatocellular carcinoma, and liver\u2010related death by fibrosis stage in the hepatitis C Alaska Cohort"],"prefix":"10.1097","volume":"66","author":[{"given":"Dana J.T.","family":"Bruden","sequence":"first","affiliation":[{"name":"Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease,Centers for Disease Control and Prevention,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"McMahon","sequence":"additional","affiliation":[{"name":"Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease,Centers for Disease Control and Prevention,Anchorage,Alaska"},{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Townshend\u2010Bulson","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhu","family":"Gounder","sequence":"additional","affiliation":[{"name":"Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease,Centers for Disease Control and Prevention,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Gove","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Plotnik","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chriss","family":"Homan","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssef","family":"Barbour","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip R.","family":"Spradling","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis, National Center for HIV\/AIDS, Viral Hepatitis, STD and TB Prevention,Centers for Disease Control and Prevention,Atlanta,Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenna C.","family":"Simons","sequence":"additional","affiliation":[{"name":"Liver Disease and Hepatitis Program,Alaska Native Tribal Health Consortium,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"McArdle","sequence":"additional","affiliation":[{"name":"University of Washington, Department of Virology, School of Medicine,Seattle,Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bruce","sequence":"additional","affiliation":[{"name":"Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease,Centers for Disease Control and Prevention,Anchorage,Alaska"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,5,22]]},"reference":[{"key":"hep29115-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1056\/NEJM199908193410802","article-title":"The prevalence of hepatitis C virus infection in the United States, 1988 through 1994","volume":"341","year":"1999","journal-title":"N Engl J Med"},{"key":"hep29115-bib-0002-20241017","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1002\/hep.26141","article-title":"Global epidemiology of hepatitis C virus infection: new estimates of age\u2010specific antibody to HCV seroprevalence","volume":"57","year":"2013","journal-title":"Hepatology"},{"key":"hep29115-bib-0003-20241017","doi-asserted-by":"crossref","first-page":"271","DOI":"10.7326\/0003-4819-156-4-201202210-00004","article-title":"The increasing burden of mortality from viral hepatitis in the United States Between 1999 and 2007","volume":"156","year":"2012","journal-title":"Ann Intern Med"},{"key":"hep29115-bib-0004-20241017","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1002\/hep.20046","article-title":"Epidemiology and risk factors for hepatitis C in Alaska natives","volume":"39","year":"2004","journal-title":"Hepatology"},{"key":"hep29115-bib-0005-20241017","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1053\/j.gastro.2009.10.056","article-title":"Adverse outcomes in Alaska Natives who recovered from or have chronic hepatitis C infection","volume":"138","year":"2010","journal-title":"Gastroenterology"},{"key":"hep29115-bib-0006-20241017","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1111\/liv.13173","article-title":"The changing epidemiology and aetiology of hepatocellular carcinoma from 1969 through 2013 in Alaska Native people","volume":"36","year":"2016","journal-title":"Liv Intl"},{"key":"hep29115-bib-0007-20241017","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1002\/hep.27950","article-title":"Hepatitis C guidance: AASLD\u2010IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus","volume":"62","year":"2015","journal-title":"Hepatology"},{"key":"hep29115-bib-0008-20241017","doi-asserted-by":"crossref","first-page":"30696","DOI":"10.3402\/ijch.v75.30696","article-title":"Results of interferon\u2010based treatments in Alaska Native and American Indian persons with chronic hepatitis C","volume":"75","year":"2016","journal-title":"Int J Circumpolar Health"},{"key":"hep29115-bib-0009-20241017","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1002\/hep.22759","article-title":"Diagnosis, management, and treatment of hepatitis C: an update","volume":"49","year":"2009","journal-title":"Hepatology"},{"key":"hep29115-bib-0010-20241017","first-page":"2031","article-title":"Estimating the date of hepatitis C virus infection from patient interviews and antibody tests on stored sera","volume":"99","year":"2004","journal-title":"Am J Gastroenterol"},{"key":"hep29115-bib-0011-20241017","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.cgh.2016.10.012","article-title":"Infection with hepatitis C virus genotype 3 is an independent risk factor for end\u2010stage liver disease, hepatocellular carcinoma, and liver\u2010related death","volume":"15","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep29115-bib-0012-20241017","doi-asserted-by":"crossref","first-page":"215","DOI":"10.7326\/M15-0406","article-title":"Restrictions for Medicaid reimbursement of sofosbuvir for the treatment of hepatitis C virus infection in the United States","volume":"163","year":"2015","journal-title":"Ann Intern Med"},{"key":"hep29115-bib-0013-20241017","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/cid\/civ860","article-title":"All\u2010cause mortality and progression risks to hepatic decompensation and hepatocellular carcinoma in patients infected with hepatitis C virus","volume":"62","year":"2016","journal-title":"Clin Infect Dis"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fhep.29115","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01515467-201707000-00007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:46:43Z","timestamp":1729212403000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01515467-201707000-00007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,22]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.29115","relation":{},"ISSN":["0270-9139","1527-3350"],"issn-type":[{"value":"0270-9139","type":"print"},{"value":"1527-3350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5,22]]},"assertion":[{"value":"2016-09-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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