 |
|
|
| |
SVR Reversed Cirrhosis in 21%
|
| |
| |
.....and cut risk of progression by 50% in this study
SUSTAINED VIROLOGICAL RESPONSE IS ASSOCIATED WITH REVERSIBILITY OF CIRRHOSIS IN CHRONIC HEPATITIS C PATIENTS
Reported by Jules Levin
43rd Annual Meeting of the European Association for the Study of the Liver
April 23-27, 2008, Milan, Italy
A.C. Cardoso1, R. Moucari1, N. Giuily1, C. Figueiredo-Mendes1, N. Boyer1, M.P. Ripault1, C. Castelnau1, T. Asselah1, M. Martinot-Peignoux2, S. Maylin2, P. Bedossa3, P. Marcellin1
1 Service d Hepatologie et INSERM U773-CRB3, 2 Service de Microbiologie, 3 Anatomie Pathologique, H™pital Beaujon, Clichy, France
Background and Aim: The reversibility of cirrhosis in chronic hepatitis C (CHC) patients who achieved sustained virological response (SVR) is controversial. The aim of this study was to assess the histological outcome of CHC patients with bridging fibrosis or cirrhosis following antiviral therapy.
Patients and Methods: 123 consecutive patients with CHC and bridging fibrosis or cirrhosis were retrospectively evaluated. They had all received at least one treatment course with interferon (conventional or pegylated) with or without ribavirin for at least 12 weeks. SVR was defined as undetectable serum HCV RNA 24 weeks after treatment discontinuation. Paired-liver biopsies obtained within a median interval of 4 years (1-17) were assessed by the same pathologist (PB) using the METAVIR Score.
Results:
Baseline characteristics of patients were: male gender (71%), mean age (55±9 years), mean BMI (25±4 kg/m2), mean serum HCV RNA level 5.7±0.6 log10IU/ml, HCV genotype 1 (66%), 2 (7%), 3 (11%), 4 (15%).
Fifty-five patients (45%) had cirrhosis (F4), and 68 (55%) bridging fibrosis (F3).
Among the 55 patients with cirrhosis, SVR developed in 24 patients (44%) and was associated with regression of cirrhosis in 11 patients (46%).
Liver histology showed a regression by one, two and three points according to METAVIR score in six (25%), three (13%), and two (8%) patients respectively.
By contrast, regression of cirrhosis was observed in only 5 patients among the 31 patients without SVR (16%), by one and two points in 4 (13%) and 1 (3%) patients respectively (p < 0.01).
Among the 63 patients with bridging fibrosis, SVR developed in 25 patients (40%) and was associated with regression of fibrosis in 9 patients (36%), by one and two points in 5 (20%) and 4 (16%) patients respectively.
Progression to cirrhosis was observed in 8 patients (32%) despite SVR. By contrast, among the 38 patients without SVR, only 6 patients (16%) showed a regression of fibrosis by one point, whereas 24 patients (63%) showed progression to cirrhosis (p < 0.01).
Conclusion: CHC patients with bridging fibrosis or cirrhosis, SVR is associated with regression of fibrosis and reversibility of cirrhosis. NR is associated with progression of fibrosis and development of cirrhosis.
In patients with bridging fibrosis or cirrhosis treated with interferon alpha-based antiviral therapy, amelioration of liver fibrosis occurred significantly more frequently among those who attained SVR than among those who did not.
Possible regression of cirrhosis was observed more frequently in patients with SVR.
Cirrhosis is reversible in chronic hepatitis C patients who attain SVR.
Fibrosis regression is a slow phenomenon, and long-term evaluation is needed to obviate (see) significant regression.
|
| |
|
|
|
|
|
