Obesity, Older Age, and Pretreatment Cirrhosis Delay Fibrosis Improvements in HCV

liver cirrhosis
liver cirrhosis
Risk factors associated with persistent fibrosis were analyzed after sustained virologic response was achieved in chronic hepatitis C.

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.

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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