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Treat HCV Early, Deferral to Cirrhosis Increases Risk for
NOT Regression & Developing HCC, Death
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AASLD/2014: Evaluation of the Health Outcomes for Ledipasvir / Sofosbuvir in Early vs. Delayed Treatment According to the Fibrosis Stage of Patients with Chronic Hepatitis C Virus (HCV) Genotype 1 Infection: Results from a Decision-Analytic Markov Model....... "initiating earlier LDV/SOF treatment at F0-2 vs F3/4 reduced liver disease progression/sequalae by 66-82% & rests in lower lifetime costs by 14.3-15.9%" - (11/17/14)
"Initiating treatment with LDV / SOF at fibrotic stages F0-F1 or F2versus F3-F4 results in a significant reduction in liver disease progression and related sequelae.......When initiating LDV / SOF treatment in F0-F1 or F2 as opposed to F3-F4, the model projected lower incidence of liver disease progression, including new cases of decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplants (LT), and HCV-related deaths (Table 5).
The estimated absolute reduction of these sequelae is 82.2% and 66.1% when initiating treatment with LDV / SOF in F0-F1 or F2 as opposed to F3-F4, respectively (Figure 2).........When initiating treatment in F0-F1, F2, or F3-F4 in treatment-naïve patients, LDV/SOF is associated with a lower lifetime cost relative to no treatment in all scenarios. The lifetime cost is lower the earlier treatment is initiated (Table 6).......treating patients with LDV/SOF in early disease reduces life-time costs, where lifetime costs are 14.3% and 15.9% lower when treatment is initiated in F2 or F0-F1, respectively, as compared to treatment initiation with LDV / SOF in F3-F4."
IAS: Frequent Fibrosis Regression With SVR in HCV/HIV+, Cutting Death Risk - (07/28/15)
Fibrosis Regression is Possible after Successful Treatment of Hepatitis C, Even with Cirrhosis - BUT Patients with F4 don't regress as often as those with earlier disease......http://www.natap.org/2015/IAS/IAS_111.htm
Liver Fibrosis Progression in Hepatitis C Virus Infection After Seroconversion: FIB-4 scores doubled in the first 4 years after infection and more than 18% of them developed cirrhosis within 10 years after infection, our data would suggest treating early ......We also determined the cumulative proportion of persons who developed cirrhosis after each year of follow-up using FIB-4 for diagnosis (Table 3). At 5 years, more than 15% of HCV+ persons had a diagnosis of cirrhosis......"Our study shows that fibrosis progression after HCV infection starts early and that a substantial proportion of HCV-infected persons develop significant fibrosis or cirrhosis within the first 5 to 10 years of infection. On the other hand, progression of cirrhosis to hepatic decompensation is uncommon in the first 9 years after cirrhosis. To our knowledge, this is the largest study of HCV-infected persons with a relatively precise estimation of the time of infection, and it provides important information about natural history of HCV infection."......http://www.natap.org/2014/HCV/121214_01.htm
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