Limited Fibrosis Progression but Significant Mortality in Patients Ineligible for Interferon-Based Hepatitis C Therapy

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• 作者：Manhal Izzy^* ; ^{mizzy@montefiore.org" class="auth_mail" title="E-mail the corresponding author} ; Ghalib Jibara^&dagger ; ; Aws Aljanabi^* ; Mustafa Alani^* ; Emily Giannattasio^* ; Hina Zaidi^* ; Zaid Said^* ; Paul Gaglio^* ; Allan Wolkoff^* ; John F. Reinus^*
• 关键词：AA ; African-American ; APRI ; aspartate-aminotransferase-to-platelet ratio index ; DTB ; dominant treatment barrier ; HCC ; hepatocellular carcinoma ; HCV ; hepatitis C virus ; SVR ; sustained virologic response
• 刊名：Journal of Clinical and Experimental Hepatology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：6
• 期：2
• 页码：100-108
• 全文大小：364 K

文摘

Individuals ineligible for interferon-based hepatitis C therapy may have a worse prognosis than patients who have failed or not received treatment.

Aims

To provide information about the limitations of medical treatment of hepatitis C in real-world patients.

Methods

We studied 969 treatment-ineligible patients and 403 treated patients enrolled between 1/1/01 and 6/30/06; data were collected until 3/31/13. Treatment barriers were grouped into five categories and classified as health-related or health-unrelated. Fibrosis stage was assessed initially and at the end of follow-up. Mortality was determined by search of the Social Security database. Death certificates of treatment-ineligible patients were reviewed.

Results

Initially, 288 individuals had advanced fibrosis and compensated disease; 87 untreated patients developed advanced fibrosis during follow-up. Health-related treatment barriers were more commonly associated with fibrosis progression and worse survival. During follow-up, 247 untreated patients died: 47% of liver-related and 53% of liver-unrelated causes. Patients with significant comorbid illness had the worst five- (70%) and ten-year (50.5%) survival. Despite high mortality (47%) in persons with decompensated liver disease, no treatment barrier was associated with a greater incidence of liver-related death. Only significant comorbid medical illness was an independent predictor of disease progression; however, it was not associated with a greater incidence of liver-related death. Furthermore, treated patients had better 10-year survival than untreated patients on Kaplan–Meier analysis (80.3% vs. 74.5%, P = 0.005).

Conclusion

Many patients with hepatitis C will die of non-liver-related causes and may not be helped by anti-viral treatment.