Effect of sustained virological response on long-term clinical outcome in 113 patients with compensated hepatitis C-related cirrhosis treated by interferon alpha and ribavirin

AIM:To assess the long-term clinical benefit of sustained virological response(SVR)in patients with hepatitis C virus(HCV)cirrhosis treated by antiviral therapy using mostly ribavirin plus interferon either standard or pegylated.METHODS:One hundred and thirteen patients with uncomplicated HCV biopsy-proven cirrhosis,treated by at least one course of antiviral treatment ≥ 3 mo and followed ≥ 30 mo were included.The occurrence of clinical events hepatocellular carcinoma(HCC),decompensation and death was compared in SVR and non SVR patients.RESULTS:Seventy eight patients received bitherapy and 63 had repeat treatments.SVR was achieved in 37 patients(33%).During a mean follow-up of 7.7 years,clinical events occurred more frequently in non SVR than in SVR patients,with a significant difference for HCC(24/76 vs 1/37,P = 0.01).No SVR patient died while 20/76 non-SVR did(P = 0.002),mainly in relation to HCC(45%).CONCLUSION:In patients with HCV-related cirrhosis,SVR is associated with a significant decrease in the incidence of HCC and mortality during a follow-up period of 7.7 years.This result is a strong argument to perform and repeat antiviral treatments in patients with compensated cirrhosis.

Pathological evolution of hepatitis C virus-“Healthy carriers”

AIM: To determine factors associated with fibrosis progression in hepatitis C virus (HCV)-infected patients without signifi cant initial pathological lesions. METHODS: Seventy six untreated HCV-infected pa-tients with initially normal liver as defi ned by a Knodell score≤3,with 2 liver biopsies and detectable HCV-RNA were included. Markers of fibrosis progression were assessed. RESULTS: Median duration of infection and time between paired biopsies was 13 (95% CI: 1-28) and 4 (95% CI: 2-16) years respectively. Alanine-transaminase (ALT) activity was normal in 43.4% of cases. 50% demonstrated progression of the necro-in? ammation and 34% of fi brosis after a median time evolution of 4 years (95% CI: 2-16). The median dif-ference in the necro-inflammation and fibrosis score between biopsies was low,1.5 and 0.0 respectively. Univariate analysis showed there was no difference between fibrosis activity or evolution according to genotype or viral load. A higher fibrosis progression (P = 0.03) was observed in patients with body mass index (BMI) > 25. Fibrosis progression correlated with the time interval between biopsies (P = 0.01). A sig-nifi cant progression of activity (1.7 vs 0.4,P < 0.05) or fi brosis (0.9 vs 0.0,P < 0.01) was observed in patients with elevated ALT. There was a signifi cant correlation between activity progression and fi brosis progression (P = 0.003). Multivariate analysis demonstrated that fi brosis progression was associated with elevated ALT,BMI > 25 and the time interval between 2 biopsies. CONCLUSION: There is no fibrosis progression in 66% of patients without signifi cant initial histopatho-logical lesion. Fibrosis progression is associated with elevated ALT and BMI > 25.