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PubMed ID:
21520194
Public Release Type:
Journal
Publication Year: 2011
Affiliation: Gastrointestinal Unit, Massachusetts General Hospital, and the Department of Medicine, Harvard Medical School, Boston, MA 02114, USA. jdienstag@partners.org
DOI:
https://doi.org/10.1002/hep.24370
Authors:
Chung RT,
King D,
Brunt EM,
Neuschwander-Tetri B,
Bacon B,
Kelley M,
Borders G,
Giansiracusa D,
Cormier M,
Banner BF,
HALT-C Trial Group,
Everhart JE,
Stoddard AM,
Morishima C,
Lok AS,
Lee WM,
Lindsay KL,
Everson GT,
Sterling RK,
Wright EC,
Szabo G,
Seeff LB,
Kim HY,
Bonkovsky HL,
Di Bisceglie AM,
Morgan TR,
Ghany MG,
Dienstag JL,
Monge F,
Goodman ZD,
Curto TM,
Bell MC,
Snow KK,
Antonov N,
Shankar R,
Apodaca MC,
Gretch DR,
Hoofmagle JH,
Robuck PR,
Haynes-Williams V,
Rivera E,
Park Y,
Kleiner D,
Liang TJ,
Smith P,
Hofmann C,
Mills AS,
Contos MJ,
Shiffman ML,
Bonham RT,
Richtmyer PA,
Greenson JK,
Fontana RJ,
Milstein SL,
Jones CB,
Govindarajan S,
Liston N,
Elbein R,
Crowder N,
Shelton J,
Malet PF,
Rogers TE,
Park C,
Sheikh M,
Jamal MM,
Craig JR,
Hoefs JC,
McKinley C,
DeSanto J,
Nash SR,
Kugelmas M,
Trouillot T,
Lundmark DP,
Molchen WA,
Bhan AK,
Reid AE,
Perrillo RP,
Lemon SM,
Kutner M,
Garcia-Tsao G,
Davis GL,
Parks M
Studies:
The Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial
The incidence of liver disease progression among subjects with histologically advanced but compensated chronic hepatitis C is incomplete. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis Trial was a randomized study of 3.5 years of maintenance peginterferon treatment on liver disease progression among patients who had not cleared virus on peginterferon and ribavirin therapy. Patients were followed subsequently off therapy. Because maintenance peginterferon treatment did not alter liver disease progression, we analyzed treated and control patients together. Among 1,050 subjects (60% advanced fibrosis, 40% cirrhosis), we determined the rate of progression to cirrhosis over 4 years and of clinical outcomes over 8 years. Among patients with fibrosis, the incidence of cirrhosis was 9.9% per year. Six hundred seventy-nine clinical outcomes occurred among 329 subjects. Initial clinical outcomes occurred more frequently among subjects with cirrhosis (7.5% per year) than subjects with fibrosis (3.3% per year) (P<0.0001). Child-Turcotte-Pugh (CTP) score≥7 was the most common first outcome, followed by hepatocellular carcinoma. Following occurrence of a CTP score≥7, the rate of subsequent events increased to 12.9% per year, including a death rate of 10% per year. Age and sex did not influence outcome rates. Baseline platelet count was a strong predictor of all clinical outcomes. During the 8 years of follow-up, death or liver transplantation occurred among 12.2% of patients with advanced fibrosis and 31.5% of those with cirrhosis.
