Durability of a sustained virological response, late clinical sequelae, and long-term changes in aspartate aminotransferase to the platelet ratio index after successful treatment with peginterferon/ribavirin for chronic hepatitis C: a prospective study.

Abstract

OBJECTIVES:

Previous studies, mostly retrospective using conventional interferon, have suggested a favorable prognosis for patients with chronic hepatitis C and a sustained virological response (SVR). However, long-term outcome, including changes in the degree of hepatic fibrosis, of SVR patients in the era of pegylated interferon (PegIFN) remains underdefined. We prospectively evaluated the long-term virological, clinical, and biochemical outcomes, including aspartate aminotransferase-to-platelet ratio index (APRI), in chronic hepatitis C patients with an SVR.

PATIENTS AND METHODS:

We included 145 consecutive, treatment-naive chronic hepatitis C patients (mean age 47.3±9.1 years; 87 men; 42.1% genotype 1; 36.6% genotype 2/3) who achieved an SVR after combination therapy with PegIFN-α/ribavirin.

RESULTS:

The mean follow-up time was 68.8±35 months. The overall incidence of hepatocellular carcinoma (HCC) and liver-related death was 1.4 and 0.7%, respectively. Among nine (7.6%) patients with pretreatment cirrhosis, two (22.2%) developed HCC and one of them (11.1%) died. No patient had conclusive evidence of late virological relapse. All patients retained normal liver biochemistry, except for five of 145 (3.5%), who had persistently elevated transaminase levels, all of whom were diagnosed with new liver disease. APRI values improved significantly with treatment (0.95±1.09 vs. 0.66±0.64, P<0.001) and continued to improve after a mean of 61.4±45.5 months from an SVR in patients (n=54; 37.2%) with significant (Metavir ≥F2) pretreatment fibrosis (1.13±0.66 vs. 0.67±0.45, P<0.001).

CONCLUSION:

The long-term outcome, including APRI, of chronic hepatitis C patients treated successfully with PegIFN/ribavirin and followed for a mean of 5.7 years is favorable. However, a high risk of progression to HCC and liver-related death remains for patients with pretreatment cirrhosis, in our setting, as high as 22.2 and 11.1%, respectively.

• Authors: Vasilios Papastergiou, Maria Stampori, Phillipos Lisgos, Crisostomos Pselas, Kleopatra Prodromidou, Stylianos Karatapanis
• Journal: European journal of gastroenterology & hepatology (Eur J Gastroenterol Hepatol) Vol. 25 Issue 7 Pg. 798-805 (Jul 2013) ISSN: 1473-5687 [Electronic] England
• PMID: 23395996 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents
• Biomarkers
• Interferon alpha-2
• Interferon-alpha
• RNA, Viral
• Recombinant Proteins
• Polyethylene Glycols
• Ribavirin
• Aspartate Aminotransferases
• peginterferon alfa-2b
• peginterferon alfa-2a

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Aspartate Aminotransferases (blood)
• Biomarkers (blood)
• Carcinoma, Hepatocellular (blood, diagnosis, virology)
• Chi-Square Distribution
• Disease Progression
• Drug Therapy, Combination
• Female
• Greece
• Hepacivirus (drug effects, genetics)
• Hepatitis C, Chronic (blood, complications, diagnosis, drug therapy, mortality)
• Humans
• Interferon alpha-2
• Interferon-alpha (therapeutic use)
• Liver Cirrhosis (blood, diagnosis, virology)
• Liver Neoplasms (blood, diagnosis, virology)
• Male
• Middle Aged
• Platelet Count
• Polyethylene Glycols (therapeutic use)
• Predictive Value of Tests
• Prospective Studies
• RNA, Viral (blood)
• Recombinant Proteins (therapeutic use)
• Ribavirin (therapeutic use)
• Risk Factors
• Time Factors
• Treatment Outcome
• Viral Load