Sustained Virological Response Increases Hepatitis C, Fibrosis, and Cirrhosis Survival Rates

Internal Medicine World ReportNovember 2014

Hepatitis C virus, fibrosis, and cirrhosis patients with sustained virological response can have survival rates comparable to the general population, according to research published in JAMA.

Patients who were able to achieve sustained virological response (SVR) had survival rates comparable to the general population, according to a research letter published November 12 in JAMA.

Investigators from the Erasmus MC University Medical Center in Rotterdam, the Netherlands, examined survival rates of patients with chronic hepatitis C virus (HCV) infection and advanced fibrosis or cirrhosis — both with and without SVR – before and after therapy treatments to the general population. Patients were included in the observation if they initiated interferon-based antiviral therapy between 1990 and 2003 at any of 5 large hepatology units in Europe or Canada. A total of 530 patients (median age: 48 years, 70% male) were followed up with for a median of 8.4 years.

SVR was defined as HCV RNA negativity in a blood sample after analysis with molecular assays, and follow up with patients started 24 weeks after cessation of the antiviral treatment. Baseline was defined as the 24-week post-cessation mark, at which researchers were able to determine whether patients achieved SVR. If patients achieved SVR after the 24 week mark, researchers allowed them to move into the SVR group as a result of successful treatment during the follow up period. Those patients were reassigned to time zero when they moved. Almost all (454 or 86%) participants completed follow up, and 13 SVR patients died. However, that did not significantly impact the age- and sex-matched Dutch population, the researchers noted. Patients were considered incomplete if researchers could not determine survival status by January 1, 2010 or contact the responsible physician or patient by October 2011.

A total of 100 patients with SVR died in the duration of the study. The researchers found the 10-year survival was 74%, which they noted was lower compared with their matched general population.

“The excellent survival among patients with advanced liver disease and SVR might be explained by the associations between SVR and regression of hepatic inflammation and fibrosis, reduced hepatic venous pressure gradient, reduced occurrence of hepatocellular carcinoma and liver failure, as well as reduced occurrence of diabetes mellitus, end-stage renal disease, and cardiovascular events,” study leader Adriaan J. van der Meer, MD, PhD, and colleagues concluded in the study. “Even though patients with cirrhosis and SVR remain at risk for hepatocellular carcinoma, the annual hepatocellular carcinoma incidence is low and survival is substantially better compared with those without SVR.”

Several prior studies demonstrated the risk of all-cause death is reduced if chronic HCV and advanced fibrosis reaches SVR, but comparisons to the general population and those without SVR in those studies have been limited. Early deaths and shorter life expectancies of these patients can be attributed to cirrhosis, liver failure, and cancer.

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