Long-term follow-up of patients with chronic hepatitis C treated with α-interferon and ribavirin antiviral therapy: clinical and fibrosis impact of treatment response.
| Autor: | Cordero-Ruiz P; aDigestive Diseases Unit bDepartment of Preventive Medicine and Public Health, Virgen Macarena University Hospital cInstitute of Biomedicine of Seville, University of Seville dUCM Inter-Centers Digestive Diseases and Ciberehd, University Hospital Virgen del Rocío, Seville, Spain., Carmona-Soria I, Rodríguez-Téllez M, Caunedo-Alvarez A, Quezada-Pacheco RH, Flores-Cucho A, Romero-Gómez M, Vilches-Arenas Á |
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| Jazyk: | angličtina |
| Zdroj: | European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2017 Jul; Vol. 29 (7), pp. 792-799. |
| DOI: | 10.1097/MEG.0000000000000886 |
| Abstrakt: | Background and Goals: The slow progression of chronic hepatitis C (CHC) infection requires long observation periods to detect clinical changes. We compare the incidence of clinical events, hepatocellular carcinoma (HCC), overall mortality, liver-related mortality, and fibrosis progression between patients with a sustained virological response (SVR) and nonresponders (NR) after a 13-year follow-up period. Study: One hundred and eighty-two CHC patients, who received interferon and ribavirin treatment between 1996 and 2000, were included. Clinical events were evaluated during follow-up. At the end of follow-up, transient elastography was used to assess fibrosis progression. Results: Of the 182 patients, 46.7% (n=85) achieved an SVR. Twenty-seven patients developed hepatic decompensation (one SVR) and 15 developed HCC (three SVR). Twenty-nine patients died (eight SVR). Twelve of the 29 deaths were liver related (two SVR). Independent factors associated with hepatic decompensation were NR to treatment [hazard ratio (HR)=23.35; 95% confidence interval (CI): 2.90-189.25; P=0.003], advanced fibrosis at baseline (HR=9.11; 95% CI: 4.13-20.09), and treatment delay after diagnosis (HR=1.02; 95% CI: 1.00-1.03; P=0.012). Only the latter two were associated with HCC development and liver-related mortality. An assessment of liver fibrosis was performed on 125 patients (66 SVR). Fibrosis values were significantly lower in SVR patients, showing less progression to advanced stages of fibrosis [SVR: 6.6 (2.8); 95% CI: 5.8-7.3] than NR [NR: 14.0 (11.1); 95% CI: 11.1-16.9; P<0.001]. Conclusion: In patients with CHC, SVR is durable and reduces clinical events. The risk of HCC development is lower, but not eliminated. Sustained responders showed fibrosis stabilization or improved fibrosis values. |
| Databáze: | MEDLINE |
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