Thursday, December 23, 2010

Hepatitis C Treatment: Long-Term Outcome In Decompensated Cirrhosis

Clin Gastroenterol Hepatol. 2010 Nov 16. [Epub ahead of print]

Long-term outcome after antiviral therapy of patients with hepatitis C virus infection and decompensated cirrhosis.
Iacobellis A, Perri F, Valvano MR, Caruso N, Niro GA, Andriulli A.

Division of Gastroenterology and Digestive Endoscopy, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo (Italy).

BACKGROUND & AIMS: We evaluated the long-term outcomes following antiviral therapy of patients with decompensated cirrhosis and hepatitis C virus (HCV) infection.

METHODS: Seventy-five patients with HCV infection and decompensated cirrhosis received therapy with peginterferon alfa-2b and ribavirin. We compared adverse-event profiles and mortality rates between patients with or without sustained virological responses (SVRs). The mean follow-up time off therapy was 51±18 months (range 3-78 months).

RESULTS: Seven patients with HCV genotypes 1 or 4 (16%) and 17 patients with genotypes 2 or 3 (55%) achieved SVRs. The mean survival times were 53 months among patients that did not achieve SVRs (95% confidence interval [CI], 48-59 months) and 73 months among those that did achieve SVRs (95% CI, 67-80 months) (P=0.004). During the study, 25 patients died (2 with and 23 without SVRs). In the follow up period, 8/24 patients with SVRs (33.3%) and 49 of 51 without SVRs (96.1%) experienced further events of decompensation (P<0.0001). The hospital re-admission rates for patients with and without SVRs were 7.4 and 56 per 1000 person-months, respectively (ratio of 7.5 without/with SVR; 95% CI, 4.0-16.0; P<0.0001). At the end of the follow-up period, the incidence of hepatocellular carcinoma was not associated with clearance of HCV.

CONCLUSIONS: Among patients with cirrhosis that is secondary to HCV infection and who have progressed to a stage of liver decompensation, an SVR following anti-viral therapy is a positive prognostic factor.

Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
PMID: 21092761 [PubMed - as supplied by publisher]

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