Modern features of the clinical course of chronic hepatitis C

Background. About 71 million people worldwide are infected with hepatitis C virus, and chronic hepatitis C often forms after the acute period, with clinical manifestations ranging from subclinical and asymptomatic cases, as well as nonspecific manifestations of liver dysfunction to manifestation of hepatitis with extrahepatic manifestations.

Objective. To present a modern clinical and laboratory characterization of the course of chronic hepatitis C in the persons observed in outpatient and inpatient conditions.

Materials and methods. Clinical and laboratory data of 77 patients who were under observation from 2021 to 2024 are presented. Complaints and anamnesis were collected, examination was performed, and medical histories were studied. The patients underwent a comprehensive laboratory and instrumental examination, as well as fibroelastometry. Also 100 conditionally healthy individuals were included.

Results. 44 individuals were observed in outpatient conditions (57.1%) and 33 patients (42.9%) underwent inpatient treatment. Among outpatients, males and females occurred with equal frequency; among inpatients, males predominated with 72.7% (p = 0.044). The median age was 44 [37; 54] years. Outpatients and inpatients did not differ statistically significantly by age. A moderate viral load was determined in 72.0% of individuals. Hepatitis C virus genotype 1 was determined in 48.6% of individuals. Viral load and genotype distribution in the patient groups were not statistically significant. Associated diseases were identified in 27.3% (n = 12) of outpatients and 93.9% (n = 31) of inpatients (p < 0.001). Among outpatients, patients were statistically significantly more likely to have no complaints (p < 0.001). Asthenic, dyspeptic, and abdominal pain syndromes were reported with statistically significantly higher frequency in patients seen as inpatients. Among inpatients, more than half of the individuals had normal ALT values, and among outpatients - moderate elevation of ALT activity (p = 0.055). In outpatients, moderate elevation of GGT was determined more often, while inpatients had normal values (p = 0.461). Both among outpatients and inpatients the persons with normal values of total bilirubin prevailed (p = 0,004). Coagulogram parameters in outpatients and inpatients did not statistically differ from reference values. Indicators of clinical blood analysis were within normal values in all groups. According to the results of fibroelastometry, fibrosis of F0-F1 stage was registered in 71.0% of all patients.

The distribution of outpatients and inpatients by fibrosis stages was not statistically significant.

Conclusion. Outpatients have no complaints in half of cases. Inpatients more often have various concomitant pathologies that can mask the clinical picture of hepatitis and affect laboratory parameters. In outpatients, a moderate increase in liver enzymes is more often detected, and in inpatients these indicators are within normal values. Indices of coagulogram and clinical blood analysis practically do not change both in outpatients and inpatients. However, in the latter, abnormalities in the clinical blood count may reflect comorbidities. At the present stage, most patients are either fibrosis-free or have mild fibrosis.

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