Indeed, we detected a strong effect of age at infection on rate of disease progression, namely a 2.8% increase in the speed of disease progression for each additional year. This significant effect is manifested by the fact that

patients infected perinatally have very slow progression of liver fibrosis. For those patients, mean progression is 0.049 FPR units, corresponding approximately to an increase of 2 Ishak selleck kinase inhibitor points in 40 years, similarly to other reports.25, 26 Additionally, male gender and HCV genotype 3 resulted in being significantly associated with fast progression, compared to female gender and HCV genotype 1, respectively. Although there is general agreement on the faster disease observed in males, the role of HCV genotype has remained controversial for a long time. According NVP-BKM120 to our data, patients with HCV genotype 3 have a faster disease progression, confirming other recent

studies.3, 4 However, whether this association is directly mediated by the virus through the increased steatosis observed in patients with HCV genotype 3 or is a consequence of other external factors is still debated.27, 28 In our models, we included an interaction term between viral genotype and steatosis to account for the reasonable different influence of steatosis according to HCV genotype. Indeed, correcting for steatosis, we still detected an effect for the HCV 3 genotype, suggesting that the faster fibrosis progression observed in genotype 3 patients appears to be not see more completely explained by the presence of steatosis. Because patients with HCV genotype 3 infection acquired the virus, in most cases, during drug abuse in the 1970s-1980s, the confounding role of past

alcohol use/abuse, even for a limited time period, cannot be completely ruled out as a relevant factor. Although, in our study, we did exclude patients reporting significant alcohol use in the past (>20g/day), we cannot completely rule out that our patients underreported alcohol consumption, especially if limited in time. Interestingly, viral genotype 2 was more weakly, but significantly, associated with a slower progression of liver fibrotic disease in our cohort. The same observation was described in a landmark article, where Poynard et al.14 reported that patients infected with genotype 2 had a slower rate of fibrosis progression relative to genotypes 1a or 1b, although the differences were not significant, presumably owing to the small number of patients with available genotypes. To confirm the results of our analyses, in spite of the limitation of the model assumptions, we also used a Cox proportional-hazard regression to directly estimate the hazard of developing advanced fibrosis as a function of host and external factors. This analysis conveniently outputs the effect of the variables on the hazard, providing useful insight on the natural history of HCV infection.