Effects of Eradicating Hepatitis C Virus Infection in Patients With Cirrhosis Differ With Stage of Portal Hypertension

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• 作者：Vito Di Marco¹ ; ^{vito.dimarco@unipa.it" class="auth_mail" title="E-mail the corresponding author} ; Vincenza Calvaruso¹ ; Donatella Ferraro² ; Maria Grazia Bavetta¹ ; Giuseppe Cabibbo¹ ; Elisabetta Conte¹ ; Calogero Camm&agrave ; ¹ ; Stefania Grimaudo¹ ; Rosaria Maria Pipitone¹ ; Fabio Simone¹ ; Sergio Peralta¹ ; Andrea Arini¹ ; Antonio Craxì ; ¹
• 关键词：Esophagus ; Bleeding ; Long-Term Outcome ; Portal Pressure
• 刊名：Gastroenterology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：151
• 期：1
• 页码：130-139.e2
• 全文大小：1053 K

文摘

Clearance of hepatitis C virus (HCV) via antiviral treatment changes the course of liver disease. We evaluated the benefit of sustained virologic response (SVR) in patients with HCV and cirrhosis without (stage 1) and with (stage 2) esophageal varices (EV).

Methods

We performed a prospective cohort study of 444 patients with HCV and compensated cirrhosis (218 with stage 1 and 226 with stage 2 disease) treated with peg-interferon and ribavirin from June 2001 through December 2009 at the University of Palermo, Italy and followed for a median of 7.6 years (range, 1−12.6 years). We used Cox regression analysis to identify variables associated with appearance or progression of EVs, development of hepatocellular carcinoma (HCC), liver decompensation, and overall survival.

Results

In the intention-to-treat analysis, 67 patients with stage 1 disease (30.7%) and 41 patients with stage 2 disease (18.1%) achieved an SVR (P = .003). Patients with stage 1 disease and an SVR were less likely to develop EVs than stage 1 patients without an SVR (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.11−0.48; P < .001). However, SVR did not affect whether patients with stage 2 disease developed further EVs (HR, 1.58; 95% CI, 0.33−1.03; P = .07, by log-rank test). An SVR was associated with lower risk for HCC (HR, 0.25; 95% CI, 0.12−0.55; P < .001). Patients with stage 2 disease, regardless of SVR, were at greater risk than patients with stage 1 disease for liver decompensation (HR, 2.82; 95% CI, 1.73−4.59; P < .001) or death (HR, 1.77; 95% CI, 1.12−2.80; P = .015). A lower proportion of patients with stage 1 disease and an SVR died from HCC (2.9%), compared with those without an SVR (11.9%) (P = .03) or developed liver decompensation (none vs 7.1% without an SVR; P = .009). A lower proportion of patients with stage 2 disease and an SVR died from causes secondary to HCC (2.0%) compared with those without an SVR (18.4%) (P = .003). Death from causes secondary to liver decompensation did not differ significantly between patients with stage 2 disease with or without an SVR (12.1% vs 25.4%; P = .15).

Conclusions

In a prospective study of 444 patients with HCV and compensated cirrhosis, HCV eradication reduced risk for liver decompensation, HCC, and death, regardless of whether the patients had EVs.