Myrna L Cozen1, James C Ryan1, Hui Shen1, Ramsey Cheung2, David E Kaplan3, Christine Pocha4, Norbert Brau5, Ayse Aytaman6, Warren N Schmidt7, Marcos Pedrosa8, Bhupinderjit S Anand9, Kyong-Mi Chang3, Timothy Morgan10, Alexander Monto11. 1. San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA. 2. Palo Alto VA Medical Center and Stanford University, 3801 Miranda Ave, GI/Hepatology #154C, Palo Alto, CA, 94304-1207, USA. 3. Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA. 4. Minneapolis VA Medical Center, 1 Veterans Drive, GI, Minneapolis, MN, 55417, USA. 5. Bronx VA Medical Center, 130 W. Kingsbridge Rd, Bronx, NY, 10468, USA. 6. New York Harbor Brooklyn and Manhattan VA Medical Centers, 800 Poly Pl, Brooklyn, NY, 11209, USA. 7. Iowa City VA Medical Center and the University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA. 8. Boston VA Health Care System and AbbVie Pharmaceuticals, 85 E. Concord St. #7700, Boston, MA, 02118, USA. 9. Houston VA Medical Center and Baylor University, Digestive Disease Section, #111D, 2002 Holcombe Blvd, Houston, TX, 77030-4211, USA. 10. Long Beach VA Medical Center and University of California Irvine, #111G, 5901 E. 7th Street, Long Beach, CA, 90822-5201, USA. 11. San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA. Alexander.Monto@va.gov.
Abstract
BACKGROUND: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated. AIM: To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients. METHODS: Patients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review. RESULTS: A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility. CONCLUSIONS: As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
BACKGROUND: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated. AIM: To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients. METHODS:Patients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review. RESULTS: A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility. CONCLUSIONS: As more hepatitis Cpatients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
Entities:
Keywords:
Cirrhosis; Hepatitis C; Hepatitis C therapy; Hepatocellular carcinoma; Survival
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