Brief Communication: The Relationship of Regression of Cirrhosis to Outcome in Chronic Hepatitis C

  1. Vincent Mallet, MD, PhD;
  2. Hélène Gilgenkrantz, MD, PhD;
  3. Jeanne Serpaggi, MD;
  4. Virginie Verkarre, MD, PhD;
  5. Anaïs Vallet-Pichard, MD;
  6. Hélène Fontaine, MD; and
  7. Stanislas Pol, MD, PhD
  1. From Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, INSERM U 567; and Assistance Publique-Hôpitaux de Paris, Hôpital Necker—Enfants Malades, Paris, France.

    Abstract

    Background: The effect of regression of cirrhosis in chronic hepatitis C is unknown.

    Objective: To evaluate the relation between regression of cirrhosis and clinical outcome in patients with chronic hepatitis C after antiviral therapy.

    Design: A cohort of patients with cirrhosis treated between 1988 and 2001.

    Setting: Hepatology unit of a tertiary care center in France.

    Patients: 96 patients with chronic hepatitis C and biopsy-proven cirrhosis (METAVIR score F4) who were treated with an interferon-based regimen and had at least 1 posttreatment liver biopsy. Patients were followed until November 2006.

    Measurements: Occurrence of a combined end point of liver-related events (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, hepatocellular carcinoma, or liver transplantation) and death in patients with regression of cirrhosis (defined as a decrease from 4 to ≤2 METAVIR units on posttherapy liver biopsy).

    Results: The median follow-up was 118 months (interquartile range, 86 to 138 months). Eighteen patients had regression of cirrhosis. The incidence of the combined end point per 100 patient-years was 0 in patients with regression of cirrhosis and 4 in patients without regression of cirrhosis (P = 0.002, log-rank test). The transplantation-free survival rate at 10 years was 100% in patients with regression of cirrhosis and 74.2% in patients without regression of cirrhosis (P = 0.025).

    Limitations: Selection of patients was retrospective; selection and survival biases may have influenced the estimates of the overall rate of regression of cirrhosis. The low number of patients who experienced regression of cirrhosis precludes analysis of factors that could predict regression of cirrhosis.

    Conclusion: Regression of cirrhosis occurs after antiviral therapy in some patients with chronic hepatitis C. Regression is associated with decreased disease-related morbidity and improved survival.

    Article and Author Information

    • Acknowledgment: The authors thank Dr. Mehran Monchi for help with statistics.

    • Potential Financial Conflicts of Interest: Honoraria: V. Mallet (Schering-Plough, Bristol-Myers Squibb), S. Pol (Bristol-Myers Squibb, Schering-Plough, Wyeth, Roche, Novartis, Gilead, Tibotec, Boehringer Ingelheim).

    • Reproducible Research Statement: Study protocol and statistical code: Not available. Data set: Available from Dr. Mallet (e-mail, vincent.mallet{at}cch.aphp.fr) after establishing written agreement with the authors.

    • Requests for Single Reprints: Stanislas Pol, MD, PhD, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France; e-mail, stanislas.pol{at}cch.aphp.fr.

    • Current Author Addresses: Drs. Mallet, Gilgenkrantz, Vallet-Pichard, Fontaine, and Pol: Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Hépatologie, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.

    • Dr. Serpaggi: Centre Hospitalier de Dreux, Hépatogastroentérologie, 44 avenue Kennedy, BP 69, 28102 Dreux, France.

    • Dr. Verkarre: Assistance Publique-Hôpitaux de Paris, Hôpital Necker—Enfants Malades, Anatomopathologie, 149 rue de Sèvres, 75015 Paris, France.

    • Author Contributions: Conception and design: V. Mallet, H. Gilgenkrantz, J. Serpaggi, A. Vallet-Pichard, S. Pol.

    • Analysis and interpretation of the data: V. Mallet, H. Gilgenkrantz, J. Serpaggi, V. Verkarre, A. Vallet-Pichard, H. Fontaine, S. Pol.

    • Drafting of the article: V. Mallet, H. Gilgenkrantz, A. Vallet-Pichard, S. Pol.

    • Critical revision of the article for important intellectual content: V. Mallet, H. Gilgenkrantz, A. Vallet-Pichard, H. Fontaine, S. Pol.

    • Final approval of the article: V. Mallet, H. Gilgenkrantz, J. Serpaggi, V. Verkarre, A. Vallet-Pichard, H. Fontaine, S. Pol.

    • Provision of study materials or patients: V. Mallet, H. Fontaine, S. Pol.

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    1. Ann Intern Med September 16, 2008 vol. 149 no. 6 399-403
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