Obesity, Older Age, and Pretreatment Cirrhosis Delay Fibrosis Improvements in HCV
Sex, pretreatment fibrosis stage, age at SVR, alcohol consumption, body mass index, and diabetes at follow-up were analyzed for association with persistent fibrosis.
Although liver fibrosis improves in many patients with chronic hepatitis C (HCV), obesity, older age, and the presence of cirrhosis before treatment represent key risk factors for improvement delays, according to findings from a cross-sectional study published in the Journal of Viral Hepatitis.
Participants in this study had chronic HCV and either pretreatment advanced fibrosis or cirrhosis and had achieved a sustained virologic response (SVR) after successful treatment with an interferon-containing regimen (n=269). In this study, a negative HCV RNA approximately 6 months after the end of treatment comprised a SVR. Investigators evaluated the effect of potential risk factors, including body mass index and age, on delayed fibrosis improvement. Patients were followed for a median of 7.7 years (range, 0-20 years).
At follow-up, a higher median liver stiffness level was observed among patients with pretreatment cirrhosis (n=119) compared with patients with advanced fibrosis (8.5 kPa; 95% CI, 7-9.1 vs 6 kPa; 95% CI, 5.5-6.4, respectively). Despite the majority of participants experiencing improvement in fibrosis after achievement of SVR, approximately 24% experienced persisting advanced fibrosis (liver stiffness level: ≥9.5 kPa).
Persisting advanced fibrosis largely diminished after 10 years vs <5 years after treatment (21% vs 48%, respectively). Findings from a multivariate analysis revealed pretreatment cirrhosis (odds ratio [OR], 3.9; 95% CI, 2.0-7.2; P <.001), age ≥55 years (OR, 2.3; 95% CI, 1.2-4.3; P =.008), and body mass index ≥25 kg/m2 (OR, 2.3; 95% CI, 1.1-4.6; P =.02) as the most significant risk factors for delayed improvement.
The cross-sectional design and retrospective nature of this study represent its primary limitations. There was also potential for selection bias, considering up to one-third of the eligible patients were lost to follow-up or excluded.
In an effort to reduce persisting advanced fibrosis after a SVR, this study indicates the importance of "[l]ife-style intervention to decrease weight in obese persons and treatment before establishment of cirrhosis at a younger age."
Hedenstierna M, Nangarhari A, El-Sabini A, Weiland O, Aleman S. Cirrhosis, high age and high body mass index are risk factors for persisting advanced fibrosis after sustained virologic response in chronic hepatitis C [published online March 8, 2018]. J Viral Hepat. doi:10.1111/jvh.12879