P L Almasio1, G Venezia, A Craxì. 1. Unit of Gastroenterology, University of Palermo, Palermo, Italy. palmasio@unipa.it
Abstract
AIM: Chronic hepatitis C is a progressive disease that leads to liver cirrhosis and hepatocellular carcinoma in a period ranging from 10 to 30 y. Many factors have been related to disease progression and, among them, persistent HCV replication has been advocated as one of the major determinant of hepatic deterioration. With this respect any treatment of chronic hepatitis C is mainly aimed to reduce necro-inflammation by suppressing viral activity in the long-term. We evaluated the persistence of HCV clearance after interferon therapy during follow-up in patients considered as long-term responders. Secondly, we analyzed the rate of progression from hepatitis to cirrhosis and hepatocellular carcinoma in patients with persistent viral elimination as compared to those who did not respond to treatment. METHODS: We performed a systematic review of published data as full papers on treatment of chronic hepatitis that reported data on long-term follow-up of patients with persistent HCV suppression and the rate of cirrhosis and hepatocellular carcinoma in long-term responders as compared to non-responders. Data were pooled to obtain a combined estimate of the reduced relative risk using the random effect model. RESULTS: In patients achieving a sustained virological response a relapse was observed in about 13% (range 0-86%). In subjects with a sustained viral response progression to cirrhosis is uncommon. When compared to relapsers or non-responders the calculated risk reduction in this group was -0.22 (95% C.I. - 0.36/-0.08). The calculated estimates of risk reduction of developing hepatocellular carcinoma in patients achieved sustained response were -0.097 (95% C.I. -0.13/-0.07). CONCLUSION: There is a high chance that patients in remission during the first 6 mo after antiviral treatment will remain so for the rest of their life. Cumulative data from literature showed a significant reduction in the rate of progression to cirrhosis and development of hepatocellular carcinoma in sustained viral responders as compared to non-responders or relapsers. However, since factors predictive of sustained response to interferon are independently associated with less frequent and/or later development of decompensation or HCC, the beneficial effects of antiviral therapy may be probably overestimated.
AIM: Chronic hepatitis C is a progressive disease that leads to liver cirrhosis and hepatocellular carcinoma in a period ranging from 10 to 30 y. Many factors have been related to disease progression and, among them, persistent HCV replication has been advocated as one of the major determinant of hepatic deterioration. With this respect any treatment of chronic hepatitis C is mainly aimed to reduce necro-inflammation by suppressing viral activity in the long-term. We evaluated the persistence of HCV clearance after interferon therapy during follow-up in patients considered as long-term responders. Secondly, we analyzed the rate of progression from hepatitis to cirrhosis and hepatocellular carcinoma in patients with persistent viral elimination as compared to those who did not respond to treatment. METHODS: We performed a systematic review of published data as full papers on treatment of chronic hepatitis that reported data on long-term follow-up of patients with persistent HCV suppression and the rate of cirrhosis and hepatocellular carcinoma in long-term responders as compared to non-responders. Data were pooled to obtain a combined estimate of the reduced relative risk using the random effect model. RESULTS: In patients achieving a sustained virological response a relapse was observed in about 13% (range 0-86%). In subjects with a sustained viral response progression to cirrhosis is uncommon. When compared to relapsers or non-responders the calculated risk reduction in this group was -0.22 (95% C.I. - 0.36/-0.08). The calculated estimates of risk reduction of developing hepatocellular carcinoma in patients achieved sustained response were -0.097 (95% C.I. -0.13/-0.07). CONCLUSION: There is a high chance that patients in remission during the first 6 mo after antiviral treatment will remain so for the rest of their life. Cumulative data from literature showed a significant reduction in the rate of progression to cirrhosis and development of hepatocellular carcinoma in sustained viral responders as compared to non-responders or relapsers. However, since factors predictive of sustained response to interferon are independently associated with less frequent and/or later development of decompensation or HCC, the beneficial effects of antiviral therapy may be probably overestimated.