Clin Infect Dis. (2013) doi: 10.1093/cid/cit234 First published online: April 24, 2013
Soo Aleman1,2, Nogol Rahbin1, Ola Weiland2, Loa Davidsdottir1, Magnus Hedenstierna2, Nina Rose1, Hans Verbaan3, Per Stål1, Tony Carlsson2, Hans Norrgren4, Anders Ekbom5, Fredrik Granath5, and Rolf Hultcrantz1
+ Author Affiliations
Correspondence to: Soo Aleman, Department of Gastroenterology and Hepatology, and Infectious Diseases, Karolinska University Hospital, at Karolinska Institute, 171 76 Stockholm, Sweden, Phone: +46 8 517 72741, Fax: +46 8 517 700 00, E-mail: soo.aleman@ki.se
Alternate corresponding author: Rolf Hultcrantz, Department of Gastroenterology and Hepatology, Karolinska University Hospital, 171 76 Stockholm, Sweden, Phone: +46 8 517 00 00, E-mail: rolf.hultcrantz@ki.se
Abstract
Background. The long-term effect of sustained virological response (SVR) to antiviral therapy on the risk to develop hepatocellular cancer (HCC), liver complications, liver-related deaths and overall death in hepatitis C (HCV) infected patients with liver cirrhosis is not fully known.
Methods. These risks were evaluated during long-term follow-up in in 351 patients with HCV related cirrhosis. 110 with SVR, 193 with non-SVR and 48 untreated patients were included in a multi-center cohort which was initiated 2001 and prospectively followed-up for a mean 5.3 ±SD 2.8 years. Complementary follow-up data from national registries were used to minimize the loss of patients during follow-up.
Results. Six patients with SVR developed HCC at 0.04, 0.64, 2.4, 7.4, 7.4 and 7.6 years after achieving SVR. The incidence of HCC, any liver complication, liver-related and overall death per 100 person-years was significantly lower in SVR time with 1.0, 0.9, 0.7, 1.9, compared to 2.3, 3.2, 3.0, 4.1 and 4.0, 4.9, 4.5, 5.1 in non-SVR and untreated time, respectively. The long-term consequences did not decline significantly after more than 3-year versus during the first 3-year of follow-up.
Conclusions. The risk for HCC, liver decompensation, and death in patients with liver cirrhosis related to HCV was markedly reduced after SVR, but a long-term risk to develop HCC remains for up to 8 years. Cirrhotic patients with HCV who achieve SVR should therefore maintain long-term surveillance for HCC. Future studies aimed to better identify those with remaining long-term risk for HCC are needed.
Received October 28, 2012. Accepted February 11, 2013.
The obvious question is why were the untreated patients untreated. It may have been - and probably was - because of alcoholism, drug use, diabetes, mental illness, or other health problems in many cases. Unless they were randomly selected from the candidates for treatment, they are not really a valid comparison for the other two groups.
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