Tuesday, July 12, 2016

HCV Infection Eradication in Cirrhosis With and Without Portal Hypertension

Atif Zaman, MD, MPH reviewing Di Marco V et al. Gastroenterology 2016 Jul. Successful treatment was associated with reduced risks for liver complications, hepatocellular carcinoma, and death, but not progression of portal hypertension. Hepatitis C virus (HCV) infection eradication in patients with cirrhosis may change the course of liver disease outcomes. Few data exist regarding the effect of HCV infection eradication on portal hypertension in this population. In a prospective cohort study performed at a single tertiary care center in Italy, researchers assessed liver-related outcomes including ascites, variceal hemorrhage, encephalopathy, hepatocellular carcinoma, and deaths in 444 patients with compensated, HCV-related cirrhosis with or without small esophageal varices. Patients underwent treatment with peginterferon and ribavirin for 48 weeks. During endoscopic screening and surveillance, the development of new varices and progression of varices were assessed. During a median follow-up of 7.6 years, the following results were observed: Sustained virologic response (SVR) at 24 weeks posttherapy was achieved in 31% of patients without varices and 18% of those with varices. Among patients without varices, achieving SVR was significantly associated with lower likelihood of developing varices (hazard ratio, 0.2). Among patients with varices, achieving SVR was not significantly associated with reduced risk for progression of varices. Regardless of whether patients had varices, achieving SVR was associated with reduced risks for liver disease complications (e.g., ascites), hepatocellular carcinoma, and mortality.