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Sustained virological response: a milestone in the treatment of chronic hepatitis C.
World J Gastroenterol 2013; 19(18):2793-8WJ

Abstract

AIM

To evaluate the long-term eradication of hepatitis C virus (HCV) infection and liver-related complications in chronically infected patients that have achieved sustained virological response.

METHODS

One hundred and fifty subjects with chronic hepatitis C (CHC) or cirrhosis and sustained virological response (SVR) between the years of 1989 and 2008 were enrolled in a long-term clinical follow-up study at the Gastrointestinal and Liver Unit of the University Hospital of Naples "Federico II". At the beginning of the study, the diagnosis of HCV infection was made on the basis of serum positivity for antibodies to HCV and detection of HCV RNA transcripts, while a diagnosis of chronic hepatitis was formulated using imaging techniques and/or a liver biopsy. SVR was achieved by interferon-based therapy, both conventional and pegylated, with and without ribavirin treatment. The patients were evaluated for follow-up at a median length of 8.6 years, but ranged from 2-19.9 years. Among them, 137 patients had pre-treatment CHC and 13 had cirrhosis. The patients were followed with clinical, biochemical, virological, and ultrasound assessments on a given schedule. Finally, a group of 27 patients underwent a liver biopsy at the beginning of the study and transient elastography at their final visit to evaluate changes in liver fibrosis.

RESULTS

The median follow-up was 8.6 years (range 2-19.9 years). HCV RNA remained undetectable in all patients, even in patients who eventually developed liver-related complications, indicating no risk of HCV recurrence. Three liver-related complications were observed: two cases of hepatocellular carcinoma and one case of bleeding from esophageal varices resulting in an incidence rate of 0.23%/person per year. Further, all three complications took place in patients diagnosed with cirrhosis before treatment began. Only one death due to liver-related causes occurred, resulting in a mortality rate of 0.077% person per year. This amounts to a 99.33% survival rate in our cohort of patients after therapy for HCV infection. Finally, of the 27 patients who underwent a liver biopsy at the beginning of the study, a reduction in liver fibrosis was observed in 70.3% of the cases; only three cases registering values of liver stiffness indicative of significant fibrosis.

CONCLUSION

Patients with CHC and SVR show an excellent prognosis with no risk of recurrence and a very low rate of mortality. Our data indicate that virus-eradication following interferon treatment can last up to 20 years.

Authors+Show Affiliations

Gastroenterology Unit, Dipartimento di Medicina Clinica e Chirurgia, University of Naples "Federico II", 80131 Naples, Italy. filomena.morisco@unina.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23687416

Citation

Morisco, Filomena, et al. "Sustained Virological Response: a Milestone in the Treatment of Chronic Hepatitis C." World Journal of Gastroenterology, vol. 19, no. 18, 2013, pp. 2793-8.
Morisco F, Granata R, Stroffolini T, et al. Sustained virological response: a milestone in the treatment of chronic hepatitis C. World J Gastroenterol. 2013;19(18):2793-8.
Morisco, F., Granata, R., Stroffolini, T., Guarino, M., Donnarumma, L., Gaeta, L., ... Caporaso, N. (2013). Sustained virological response: a milestone in the treatment of chronic hepatitis C. World Journal of Gastroenterology, 19(18), pp. 2793-8. doi:10.3748/wjg.v19.i18.2793.
Morisco F, et al. Sustained Virological Response: a Milestone in the Treatment of Chronic Hepatitis C. World J Gastroenterol. 2013 May 14;19(18):2793-8. PubMed PMID: 23687416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sustained virological response: a milestone in the treatment of chronic hepatitis C. AU - Morisco,Filomena, AU - Granata,Rocco, AU - Stroffolini,Tommaso, AU - Guarino,Maria, AU - Donnarumma,Laura, AU - Gaeta,Laura, AU - Loperto,Ilaria, AU - Gentile,Ivan, AU - Auriemma,Francesco, AU - Caporaso,Nicola, PY - 2012/08/31/received PY - 2013/03/08/revised PY - 2013/03/15/accepted PY - 2013/5/21/entrez PY - 2013/5/21/pubmed PY - 2013/12/16/medline KW - Antiviral therapy KW - Cirrhosis KW - Fibrosis KW - Hepatitis C virus KW - Sustained virological response SP - 2793 EP - 8 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 19 IS - 18 N2 - AIM: To evaluate the long-term eradication of hepatitis C virus (HCV) infection and liver-related complications in chronically infected patients that have achieved sustained virological response. METHODS: One hundred and fifty subjects with chronic hepatitis C (CHC) or cirrhosis and sustained virological response (SVR) between the years of 1989 and 2008 were enrolled in a long-term clinical follow-up study at the Gastrointestinal and Liver Unit of the University Hospital of Naples "Federico II". At the beginning of the study, the diagnosis of HCV infection was made on the basis of serum positivity for antibodies to HCV and detection of HCV RNA transcripts, while a diagnosis of chronic hepatitis was formulated using imaging techniques and/or a liver biopsy. SVR was achieved by interferon-based therapy, both conventional and pegylated, with and without ribavirin treatment. The patients were evaluated for follow-up at a median length of 8.6 years, but ranged from 2-19.9 years. Among them, 137 patients had pre-treatment CHC and 13 had cirrhosis. The patients were followed with clinical, biochemical, virological, and ultrasound assessments on a given schedule. Finally, a group of 27 patients underwent a liver biopsy at the beginning of the study and transient elastography at their final visit to evaluate changes in liver fibrosis. RESULTS: The median follow-up was 8.6 years (range 2-19.9 years). HCV RNA remained undetectable in all patients, even in patients who eventually developed liver-related complications, indicating no risk of HCV recurrence. Three liver-related complications were observed: two cases of hepatocellular carcinoma and one case of bleeding from esophageal varices resulting in an incidence rate of 0.23%/person per year. Further, all three complications took place in patients diagnosed with cirrhosis before treatment began. Only one death due to liver-related causes occurred, resulting in a mortality rate of 0.077% person per year. This amounts to a 99.33% survival rate in our cohort of patients after therapy for HCV infection. Finally, of the 27 patients who underwent a liver biopsy at the beginning of the study, a reduction in liver fibrosis was observed in 70.3% of the cases; only three cases registering values of liver stiffness indicative of significant fibrosis. CONCLUSION: Patients with CHC and SVR show an excellent prognosis with no risk of recurrence and a very low rate of mortality. Our data indicate that virus-eradication following interferon treatment can last up to 20 years. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/23687416/Sustained_virological_response:_a_milestone_in_the_treatment_of_chronic_hepatitis_C_ L2 - http://www.wjgnet.com/1007-9327/full/v19/i18/2793.htm DB - PRIME DP - Unbound Medicine ER -