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Rapid Responses to:
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Electronic letters published:
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Regression of Cirrhosis and Clinical Outcomes in Patients with Chronic Hepatitis C and Cirrhosis
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Vincent Mallet, MD, Ph.D Université Paris Descartes; APHP, Hôpital Cochin, Hépatologie; INSERM U. 567, Hélène Gilgenkrantz, Stanislas Pol
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vincent.mallet{at}cch.aphp.fr Vincent Mallet, et al.
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The recent report by Feldt et al. confirms that sustained viral response (SVR) to antiviral treatment is associated with improved outcome in patients with chronic hepatitis C, especially in those with advanced fibrosis (Ishak 4) or cirrhosis (Ishak 5 or 6) (1-3). We have recently reported similar results in 89 consecutively treated patients with chronic hepatitis C who had compensated (Child A) biopsy-proven cirrhosis at inclusion (4) with a median 10-year follow-up period (862 patient-year) (Mallet et al, American Association for the Study of Liver Diseases. Boston, MA. 2007). Patients were stratified on the basis of the decrease of their histopathological fibrosis score on a post-therapeutic liver biopsy. Observed liver-related complications and survival rates were compared between patients with or without regression of cirrhosis, defined as a decrease from 4 to less than, or equal to, 2 METAVIR units (5), and between patients with or without sustained viral response, defined as the absence of detectable hepatitis C virus RNA, 24 weeks after the end of treatment. The median follow-up period was 119 months for patients with regression of cirrhosis (interquartile range, 92 to 134 months) and 120 months (interquartile range, 87 to 140 months) for patients without cirrhosis-reversal (P=0.63; T-test). Sustained viral response was achieved in 39 patients. During the follow-up process, 17 patients with persistent cirrhosis developed at least one cirrhosis-related complication, and among them 13 developed hepatocellular carcinoma. The incidence of liver-related complications, including hepatocellular carcinoma, was lower in patients with SVR (P=0.022 by the log-rank test) but three patients with persistent cirrhosis developed hepatocellular carcinoma despite complete response to therapy. More original and interesting was the impact of cirrhosis reversal on the outcome of patients. Regression of cirrhosis was observed in 22 patients. Twenty of them were long-term responders to therapy and two were biochemical responders (normal liver function tests, no detectable activity on liver biopsy, but persistent viremia) to anti-hepatitis C therapy. No complication occurred in the group of patients with regression of cirrhosis. During the follow-up, 15 patients without regression died (n=11) or underwent liver transplantation (n=4) while none of the 22 patients with regression did (p=0.038 by the log-rank test). Our results confirm the benefits associated with a sustained viral response in cirrhotic patients, and evidence that regression of cirrhosis is the main end-point to cancel cirrhosis-related morbidity and mortality. 1. Braks RE, Ganne-Carrie N, Fontaine H, Paries J, Grando-Lemaire V, Beaugrand M, et al. Effect of sustained virological response on long-term clinical outcome in 113 patients with compensated hepatitis C-related cirrhosis treated by interferon alpha and ribavirin. World J Gastroenterol. 2007;13(42):5648-53. 2. Bruno S, Stroffolini T, Colombo M, Bollani S, Benvegnu L, Mazzella G, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology. 2007;45(3):579-87. 3. Di Marco V, Almasio PL, Ferraro D, Calvaruso V, Alaimo G, Peralta S, et al. Peg-interferon alone or combined with ribavirin in HCV cirrhosis with portal hypertension: a randomized controlled trial. J Hepatol. 2007;47(4):484-91. 4. Serpaggi J, Carnot F, Nalpas B, Canioni D, Guechot J, Lebray P, et al. Direct and indirect evidence for the reversibility of cirrhosis. Hum Pathol. 2006;37(12):1519-26. 5. Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97(10):2614- 8. Conflict of Interest:None declared |
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