Curative HCV Treatment Halts Liver Fibrosis Progression
SVR was independently associated with protection from liver fibrosis progression after adjustments for baseline ALT, duration of HCV infection, and mode of acquisition.
Sustained virologic response (SVR) in individuals with chronic hepatitis C virus (HCV) is associated with protection from liver fibrosis progression, according to data published in PLoS One.
Researchers from St. Vincent's Hospital in Melbourne, Australia, conducted a long-term follow-up study to identify rates of liver fibrosis progression in a cohort of patients with chronic HCV who underwent liver biopsy before 2004 and a follow-up liver fibrosis assessment more than 10 years later. Investigators examined the association between SVR and rate of liver fibrosis progression over 10 years, defined as an increase from mild-moderate fibrosis at baseline to advanced fibrosis at follow-up.
A total of 131 participants were included in the analysis (69% male; median age at follow-up, 57 years). The average duration of HCV infection was 33 years, with a median period of 14 years between fibrosis assessments. Liver fibrosis assessment at follow-up was performed by liver stiffness measurement in 86% of participants and by liver biopsy in 14%. The researchers found that 83% of participants had received interferon-based antiretroviral therapy and 40% attained SVR.
Results showed that the proportion of participants with advanced liver fibrosis increased at follow-up (27% at baseline vs 46% at follow-up; P =.002). However, the prevalence of advanced fibrosis did not change among participants who achieved SVR (30% at baseline vs 25% at follow-up; P =.343). In addition, the prevalence of advanced fibrosis increased among participants with persistent viremia (10% at baseline vs 31% at follow-up; P =.0001).
Overall, SVR was independently associated with lower liver fibrosis progression after adjustments for variables including baseline alanine aminotransferase level (P =.011), duration of HCV infection, and mode of acquisition.
The investigators note that the patient population of this study may be overrepresented by more severe illness and rapid disease progression compared with a community-based cohort because the participants were identified from an HCV database. They add that behavioral factors such as alcohol consumption, marijuana use, and coffee consumption were not included in the analysis.
“Our results contribute to the growing body of evidence that curative HCV treatment prevents long-term fibrosis progression, and supports the notion that access to [direct acting antiviral] therapy should be made widely available to all individuals regardless of fibrosis stage,” the investigators concluded.
Chen Yi Mei SLG, Thompson AJ, Christensen B, et al. Sustained virological response halts fibrosis progression: a long-term follow-up study of people with chronic hepatitis C infection. PLoS One. 2017;12(10):e0185609.