AbstractBackground and aims: Chronic hepatitis C infection represents an increasing health problem globally, not least in the developing countries. The natural history of the disease is controversial and is poorly studied in Pakistanis. The aim of this study was to determine the significance of native country for the stage of liver fibrosis in a population of HCV patients of Pakistani or Scandinavian origin living in Oslo. Patients and methods: A total of 133 HCV patients, 78 of Scandinavian and 55 of Pakistani origin, met the inclusion criteria based on detectable serum HCV-RNA and an available liver biopsy. Demographical, clinical, virological, biochemical and histological data for the two groups were examined retrospectively. Results: Among the patients of Pakistani origin, more patients had bridging fibrosis/cirrhosis on liver biopsy than among the Scandinavian patients (49% vs. 19%; p<.0003). There were also more patients with liver steatosis (64% vs. 32%; p=.001) and ALT and AST levels above the reference range (95% vs. 83%; p=.044 and 87% vs. 66%; p=.005) in the Pakistani group. Logistic regression analysis identified age and Pakistani origin as the only independent predictors of bridging fibrosis/cirrhosis.Conclusions: HCV patients of Pakistani origin had more advanced liver disease than those of Scandinavian origin. This can be explained by longer duration of the infection and more comorbidity like liver steatosis, diabetes mellitus and HBV co-infection in the Pakistani group. We encourage Norwegian physicians to take this into consideration when encountering this patient group.