July 11, 2013
Abigail Zuger, MD reviewing Aleman S et al. Clin Infect Dis 2013 Jul 15. Pereira OC and Feld JJ. Clin Infect Dis 2013 Jul 15.
Not in patients with cirrhosis, who still risk both decompensated cirrhosis and hepatocellular carcinoma.
Although eradication of hepatitis C virus (HCV) infection with combined antiviral therapy generally will halt or even reverse liver pathology, risk for bad outcomes such as decompensated cirrhosis or hepatocellular carcinoma (HCC) is not eliminated. But exactly how common are these life-threatening complications of HCV in patients with sustained virologic responses (SVRs) to HCV treatment?
Swedish researchers prospectively followed 351 patients with HCV-related cirrhosis for a mean 5.3 years. Among 110 patients with SVRs to interferon-based treatment, HCC incidence was 5%, compared with 13% among 198 treated patients without SVRs and 29% among 48 untreated patients. Risks for any clinical decompensation (i.e., ascites, variceal bleeding, or encephalopathy), liver-related mortality, and all-cause mortality all followed the same pattern: highest among the untreated, lower among the unsuccessfully treated, and lowest (but not zero) among the successfully treated.
Sweden's comprehensive national health registries make these data among the most precise available on the long-term outcomes of HCV treatment started after a patient already has progressed to cirrhosis. Editorialists note that risk for hepatocellular carcinoma in successfully treated cirrhotic patients is low enough that routine sonographic screening generally would not be considered cost-effective, but they endorse ongoing screening of these patients nonetheless.
Disclosures for Abigail Zuger, MD at time of publication Editorial boards Journal Watch AIDS Clinical Care; Clinical Infectious Diseases Other New York Times medical writer
Aleman S et al. A risk for hepatocellular carcinoma persists long-term after sustained virologic response in patients with hepatitis C–associated liver cirrhosis. Clin Infect Dis 2013 Jul 15; 57:230. (http://dx.doi.org/10.1093/cid/cit234)
Pereira OC and Feld JJ. Sustained virologic response for patients with hepatitis C–related cirrhosis: A major milestone, but not quite a cure. Clin Infect Dis 2013 Jul 15; 57:237. (http://dx.doi.org/10.1093/cid/cit237)