Successful anti-viral treatment improves survival of patients with advanced liver disease due to chronic hepatitis C.

ABSTRACT

BACKGROUND: Long-term outcome of chronic hepatitis C patients with successful viral eradication seems to be promising. AIM: To evaluate mortality, incidence of hepatocellular carcinoma (HCC), liver failure and liver transplantation in sustained virological responders (SVR) and non-SVR patients with different stages of fibrosis. METHODS: Seven hundred and fourteen patients with a follow-up of 7.2 (1-21.1) years (age 51.4 ± 12.0 years, 276 female, IFN-monotherapy n = 19, IFN/RBV n = 122, peg-IFN/RBV n = 573, SVR 551, non-SVR 163) were studied. Two hundred and ten of 540 patients with a liver biopsy prior to treatment had advanced stages of fibrosis (Metavir F3/F4). RESULTS: Forty-eight patients died during follow-up, 15 with SVR and 33 without (P < 0.001). Five- and 10-year mortality rates were 1.8% (10/551) and 2.7% (15/551) in the SVR group and 8.6% (14/163) and 19.1% (31/163) in the non-SVR patients (P < 0.001). In 29 patients, decompensation of liver disease [SVR 9 (1.6%) vs. non-SVR 20 (12.3%); P < 0.001] occurred and in 29 patients, HCC developed during follow-up [SVR 10 (1.8%) vs. non-SVR 19 (11.7%); P < 0.001]. Non-SVR was an independent predictor for developing (i) HCC [HR 2.36 (95% CI 1.07-5.23; P = 0.034], (ii) liver-related complications [HR 2.62; (95% CI 1.18-5.81; P = 0.018] and (iii) mortality (HR 3.46; 95% CI 1.91-6.29; P < 0.001). For patients with early stages of fibrosis (F0-F2), a survival benefit of SVR patients could not be demonstrated. CONCLUSIONS: Successful anti-viral therapy decreases mortality, incidence of hepatocellular carcinoma and liver failure in patients with advanced fibrosis. However, hepatocellular carcinoma development or liver failure are not prevented completely, and further follow-up of patients is advisable.