BACKGROUND & AIMS: There are limited data on the efficacy and safety of antiviral therapy in patients with hepatitis C virus (HCV)-related cirrhosis, particularly on the impact of portal hypertension. METHODS: We assessed hepatovenous pressure gradient (HVPG), liver stiffness (transient elastography), and interleukin (IL)-28B polymorphisms (rs12979860) in 90 cirrhotic patients with HCV infection (82% genotype 1 or 4) before antiviral therapy with pegylated interferon and ribavirin. Efficacy and safety were evaluated. RESULTS: Rates of sustained virologic response were significantly lower among patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mm Hg; n = 50) than among patients without CSPH (HVPG <10 mm Hg; n = 40): 14% vs 51% (P = .0007). Seventy-nine percent and 83% of patients with CSPH and without CSPH, respectively, received more than 80% of planned dose (P = .647). The predictive value of HVPG (area under the curve [AUC], 0.743) was greater than that of liver stiffness (AUC, 0.647) or of baseline HCV RNA levels (AUC, 0.620). The IL-28B polymorphism was not associated significantly with a sustained virologic response. Multivariate analysis revealed that HVPG (odds ratio [OR], 14.3; P = .009), baseline HCV RNA levels (OR, 5.3; P = .019), and HCV genotype (OR, 6.5; P = .046) were independent risk factors for treatment failure. A trend toward higher incidence of anemia and neutropenia was observed for patients with CSPH. The incidence and grade of thrombocytopenia were significantly higher among patients with than without CSPH (94% vs 75%; P = .006). CONCLUSIONS: HVPG is an independent predictor of response to antiviral therapy, with better predictive value than liver stiffness, baseline HCV RNA levels, HCV genotype, or IL-28B polymorphism. The incidence and grade of thrombocytopenia during antiviral therapy are higher among patients with CSPH. In evaluating cirrhotic HCV patients for antiviral treatment, measurement of HVPG should be considered.
BACKGROUND & AIMS: There are limited data on the efficacy and safety of antiviral therapy in patients with hepatitis C virus (HCV)-related cirrhosis, particularly on the impact of portal hypertension. METHODS: We assessed hepatovenous pressure gradient (HVPG), liver stiffness (transient elastography), and interleukin (IL)-28B polymorphisms (rs12979860) in 90 cirrhotic patients with HCV infection (82% genotype 1 or 4) before antiviral therapy with pegylated interferon and ribavirin. Efficacy and safety were evaluated. RESULTS: Rates of sustained virologic response were significantly lower among patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mm Hg; n = 50) than among patients without CSPH (HVPG <10 mm Hg; n = 40): 14% vs 51% (P = .0007). Seventy-nine percent and 83% of patients with CSPH and without CSPH, respectively, received more than 80% of planned dose (P = .647). The predictive value of HVPG (area under the curve [AUC], 0.743) was greater than that of liver stiffness (AUC, 0.647) or of baseline HCV RNA levels (AUC, 0.620). The IL-28B polymorphism was not associated significantly with a sustained virologic response. Multivariate analysis revealed that HVPG (odds ratio [OR], 14.3; P = .009), baseline HCV RNA levels (OR, 5.3; P = .019), and HCV genotype (OR, 6.5; P = .046) were independent risk factors for treatment failure. A trend toward higher incidence of anemia and neutropenia was observed for patients with CSPH. The incidence and grade of thrombocytopenia were significantly higher among patients with than without CSPH (94% vs 75%; P = .006). CONCLUSIONS: HVPG is an independent predictor of response to antiviral therapy, with better predictive value than liver stiffness, baseline HCV RNA levels, HCV genotype, or IL-28B polymorphism. The incidence and grade of thrombocytopenia during antiviral therapy are higher among patients with CSPH. In evaluating cirrhotic HCVpatients for antiviral treatment, measurement of HVPG should be considered.
Authors: K Neukam; L E Morano-Amado; A Rivero-Juárez; J Macías; R Granados; A Romero-Palacios; M Márquez; D Merino; E Ortega; J C Alados-Arboledas; J Cucurull; M Omar; P Ryan-Murua; J A Pineda Journal: Eur J Clin Microbiol Infect Dis Date: 2016-12-21 Impact factor: 3.267
Authors: Peter Ferenci; Rodrigo Aires; Kimberly L Beavers; Manuela Curescu; Paulo R Abrão Ferreira; Michael Gschwantler; Stefan Ion; Dominique Larrey; Mojca Maticic; Massimo Puoti; János Schuller; Istvan Tornai; Anna Tusnádi; Diethelm Messinger; Fernando Tatsch; Andrzej Horban Journal: Hepatol Int Date: 2013-11-22 Impact factor: 6.047
Authors: T Reiberger; A Ferlitsch; B A Payer; M Pinter; M Homoncik; M Peck-Radosavljevic Journal: J Gastroenterol Date: 2011-12-15 Impact factor: 7.527
Authors: Thomas Reiberger; Arnulf Ferlitsch; Berit Anna Payer; Matthias Pinter; Philipp Schwabl; Judith Stift; Michael Trauner; Markus Peck-Radosavljevic Journal: Wien Klin Wochenschr Date: 2012-06-15 Impact factor: 1.704
Authors: V Saxena; M M Manos; H S Yee; L Catalli; E Wayne; R C Murphy; V A Shvachko; M P Pauly; J Chua; A Monto; N A Terrault Journal: Aliment Pharmacol Ther Date: 2014-03-24 Impact factor: 8.171