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LONG-TERM FOLLOW-UP OF CHRONIC HEPATITIS C PATIENTS - RESPONSE TO THERAPY AND INCIDENCE OF LIVER-RELATED COMPLICATIONS
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AASLD 2003, abstract 562
Pierre Pradat, Hotel-Dieu, Lyon, France; Hans L Tillmann, Medizinische Hochschule, Hannover, Germany; Jean-Henrik Braconier, University Hospital of Lund, Lund, Sweden; Giorgio Saracco, Azienda Ospedaliera San Giovanni Battista, Torino, Italy; Silvia Sauleda, Hospital General Vall d'Hebron, Barcelona, Spain; Mark Thursz, St. Mary's Hospital, London, UK; Paule Merle, Hotel-Dieu, Lyon, France; Salvatore Badalamenti, Schering-Plough Research Institute, Kenilworth, NJ; Alfredo Alberti, Universita di Padova, Padova, Italy; Juan-Ignacio Esteban, Hospital General Vall d'Hebron, Barcelona, Spain; Stephanos Hadziyannis, Hippokration Hospital, Athens, Greece; Mario Rizzetto, Azienda Ospedaliera San Giovanni Battista, Torino, Italy; Howard Thomas, St. Mary's Hospital, London, UK; Michael Manns, Medizinische Hochschule, Hannover, Germany; Christian Trépo, Hotel-Dieu, Lyon, France
Background:
Large long-term follow-up studies of patients with hepatitis C virus (HCV) infection are rare. Therefore, the long-term response to therapy and the prevalence of HCV-related hepatic and extrahepatic complications are poorly known.
Objectives:
In this study, we re-analyzed a large European cohort of HCV patients (the HENCORE cohort), 5-7 years after the inclusion of the patients. Methods : 1650 patients from eight European Centers were enrolled in this cohort between 1996 and 1997. Histological assessment was performed on centralized pre-treatment liver biopsies using the Ishak scoring system (HAI). These preliminary results are based on the follow-up of 650 patients.
Results:
Among 35 patients classified in 1996 as resolved acute hepatitis, 4 relapsed during the follow-up period (11.4%) and became HCV-RNA positive by PCR.
Similarly, among 59 patients classified as sustained virological responders (SVR) after antiviral therapy, 7 relapsed during the follow-up (12%). (editorial note: other studies have reported 95% of patients with SVR maintain response for up to 11 years of follow-up).
One hundred and eighty-five patients initially classified as non-responders (NR) have been followed up. Among them, 102 were re-treated during the follow-up period (43% by IFN/riba, 19% by IFN alone, 15% by PEG/riba, 15% by ribavirin alone and 8% by another treatment). Among these re-treated patients, 29% achieved a SVR, 52% were NR and 19% relapsed.
About 9% of patients with an initial HAI fibrosis score between 2 and 4 developed an HCV-related liver complication such as cirrhosis and hepatocarcinoma (HCC) or needed a liver transplantation during the follow-up period. For patients with an HAI fibrosis score of 0 or 1, the proportion of complications decreased only slightly to 6.6%.
Two patients with a fibrosis score of 3 and 4 respectively developed an HCC during the follow-up. Among patients with a fibrosis score of 5 or 6, 27% developed an HCC and/or died.
Conclusion:
Long-term follow-up of HCV patients is necessary since an important proportion of patients considered as having cleared the virus (spontaneously or after antiviral therapy) may relapse over time. HCV-related liver complications may develop rapidly even in patients with mild histological damage. |
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