Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: A 5-year follow-up of 150 patients

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Hepatology. 2008 Nov 13. [Epub ahead of print]

Clinical, virologic, histologic, and biochemical outcomes after successful HCV

therapy: A 5-year follow-up of 150 patients.

SL, Bacon BR, Brunt EM, Mihindukulasuriya KL, Hoffmann J, Di Bisceglie

AM.

Saint Louis University Liver Center and the Division of Gastroenterology,

Department of Internal Medicine, Saint Louis University, St. Louis, MO.

One hundred fifty patients with sustained virologic response (SVR) after

treatment of chronic hepatitis C were enrolled in a long-term clinical follow-up

study; patients were followed for 5 years for liver-related outcomes and

evidence of biochemical or virologic relapse. Patients with stage 2 or greater

fibrosis on pretreatment biopsy were invited to undergo a long-term follow-up

biopsy after their fourth year of follow-up. One hundred twenty-eight patients

(85%) were followed through their fourth year, and long-term follow-up biopsies

were obtained from 60 patients (40%). Forty-nine patients had paired

pretreatment and long-term follow-up biopsies blindly rescored. Forty of these

patients (82%) had a decrease in fibrosis score, and 45 (92%) had a decrease in

combined inflammation score. Ten patients (20%) had normal or nearly normal

livers on long-term follow-up biopsy. Two patients with pretreatment cirrhosis

developed hepatocellular carcinoma (HCC), and one died. All the other patients

with pretreatment cirrhosis or advanced fibrosis had improved fibrosis scores on

long-term follow-up biopsy. No patient had conclusive evidence of virologic

relapse. Three patients had persistently elevated alanine aminotransferase

levels; two of these had new liver disease. Conclusion: In a cohort of 150

patients with SVR followed for 5 years, the majority of patients had good

outcomes. Serum virologic relapse was not seen, but two patients with

pretreatment cirrhosis developed HCC, and one died. In a blind rescoring of 49

paired pretreatment and long-term follow-up biopsies, 82% improved fibrosis

scores and 92% improved at least one component of inflammation. A minority of

patients had normal or nearly normal liver tissue on long-term follow-up biopsy.

Patients with cirrhosis pretreatment are at a low but real risk of HCC after

SVR. (HEPATOLOGY 2009.).

PMID: 19072828 [PubMed - as supplied by publisher]