A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C (HEP-10-2210).

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Hepatology. 2011 Apr 21. doi: 10.1002/hep.24370. [Epub ahead of print]

A prospective study of the rate of progression in compensated, histologically

advanced chronic hepatitis C (HEP-10-2210).

Dienstag JL, Ghany MG, TR, Di Bisceglie AM, Bonkovsky HL, Kim HY, Seeff

LB, Szabo G, EC, Sterling RK, Everson GT, KL, Lee WM, Lok AS,

Morishima C, Stoddard AM, Everhart JE; for the HALT-C Trial Group.

Source

Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA and the

Department of Medicine, Harvard Medical School, Boston, MA.

jdienstag@....

Abstract

BACKGROUND & AIMS:

The incidence of liver disease progression among subjects with histologically

advanced but compensated, chronic hepatitis C is incomplete.

METHODS:

The Hepatitis C Antiviral Long-term Treatment against Cirrhosis Trial was a

randomized study of 3.5 years of maintenance peginterferon treatment on liver

disease progression among patients who had not cleared virus on peginterferon

and ribavirin therapy. Patients were followed subsequently off therapy. Because

maintenance peginterferon treatment did not alter liver disease progression, we

analyzed treated and control patients together. Among 1,050 subjects (60%

advanced fibrosis, 40% cirrhosis), we determined the rate of progression to

cirrhosis over 4 years and of clinical outcomes over 8 years.

RESULTS:

Among patients with fibrosis, the incidence of cirrhosis was 9.9% per year. 679

clinical outcomes occurred among 329 subjects. Initial clinical outcomes

occurred more frequently among subjects with cirrhosis (7.5%/year) than with

fibrosis (3.3%/year) (P <0.0001). Child-Turcotte-Pugh (CTP) ™7 was the most

common first outcome, followed by hepatocellular carcinoma. Following occurrence

of a score CTP ™7, the rate of subsequent events increased to 12.9%/year,

including a death rate of 10%/year. Age and sex did not influence outcome rates.

Baseline platelet count was a strong predictor of all clinical outcomes. During

the 8 years of follow-up, death or liver transplantation occurred among 12.2% of

patients with advanced fibrosis and 31.5% of those with cirrhosis.

CONCLUSIONS:

Among patients with advanced hepatitis C who failed peginterferon and ribavirin,

the rate of liver-related outcomes, including death and liver transplantation,

is high, especially once CTP reaches at least 7. (HEPATOLOGY 2011.).

Copyright ¿ 2011 American Association for the Study of Liver Diseases.

PMID: 21520194 [PubMed - as supplied by publisher]