Long-term outcome of chronic hepatitis C after sustained virological response to interferon-based therapy

Autor:	Christopher Koh, Theo Heller, V. Haynes-Williams, Jordan J. Feld, Marc G. Ghany, Jay H. Hoofnagle, T. J. Liang, David E. Kleiner, Xiongce Zhao, Koji Hara, Yaron Rotman
Rok vydání:	2013
Předmět:	Male Oncology Hepacivirus Polyethylene Glycols chemistry.chemical_compound Liver Function Tests Interferon Pharmacology (medical) Longitudinal Studies Young adult Aged 80 and over biology medicine.diagnostic_test Gastroenterology virus diseases Hepatitis C Middle Aged Recombinant Proteins Treatment Outcome Female medicine.drug Adult medicine.medical_specialty Adolescent Alpha interferon Interferon alpha-2 Antiviral Agents Article Young Adult Internal medicine Ribavirin medicine Humans Interferon alfa Aged Hepatology business.industry Interferon-alpha Hepatitis C Chronic biology.organism_classification medicine.disease digestive system diseases chemistry Immunology Liver function tests business Biomarkers Follow-Up Studies
Zdroj:	Alimentary Pharmacology & Therapeutics. 37:887-894
ISSN:	0269-2813 1463-1113
DOI:	10.1111/apt.12273
Popis:	Although the short-term benefits of a sustained virological response (SVR) to interferon-based therapies of chronic hepatitis C (CHC) are well known, the long-term consequences of SVR are less clear.To assess changes in markers of disease activity and fibrosis in patients followed up to 23 years post-SVR.The first 103 SVR patients (from 1984 to 2003) at the National Institutes of Health Clinical Center were evaluated. Serum markers before treatment and at the last visit were compared. Evaluations after 2007 included transient elastography (TE).Of 103 patients, three subsequently relapsed 0.7, 6.3 and 6.5 years post therapy. The remaining 100 patients (56 men, mean age 56 years) maintained SVR at final follow-up. No patients developed hepatic decompensation, but one with pre-treatment cirrhosis died 12 years post SVR of hepatocellular carcinoma. In comparison to pre-treatment values, markers improved at follow-up, including mean ALT (152-27 U/L), AST (87-24 U/L), alkaline phosphatase (78-69 U/L), IgG (1463-1113 mg/dL), platelet count (209 000-239 000/μL) and AST to platelet count ratio index (APRI: 1.31-0.33). TE was performed in 69 patients and was normal (7.0 kPA) in 60%, moderately elevated (7.1-13.8) in 31% and cirrhotic range (13.8) in 9%. TE and platelet counts at follow-up correlated with fibrosis on pre-treatment liver biopsy (P0.001).In 97% of patients with CHC, SVR is durable without evidence of disease progression, although some degree of hepatic fibrosis may persist and patients with pre-treatment cirrhosis are at continuing low risk for hepatocellular carcinoma.
Databáze:	OpenAIRE
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