Durability of a sustained virological response, late clinical sequelae, and long-term changes in aspartate aminotransferase to the platelet ratio index after successful treatment with peginterferon/ribavirin for chronic hepatitis C: a prospective study

作者：Papastergiou Vasilios^*; Stampori Maria; Lisgos Phillipos; Pselas Crisostomos; Prodromidou Kleopatra; Karatapanis Stylianos

来源：European Journal of Gastroenterology and Hepatology, 2013, 25(7): 798-805.

DOI：10.1097/MEG.0b013e32835eb8bf

• aspartate aminotransferase-to-platelet ratio index
• chronic hepatitis C
• follow-up
• hepatocellular carcinoma
• pegylated interferon
• sustained virological response

Objectives Previous studies, mostly retrospective using conventional interferon, have suggested a favorable prognosis for patients with chronic hepatitis C and a sustained virological response (SVR). However, long-term outcome, including changes in the degree of hepatic fibrosis, of SVR patients in the era of pegylated interferon (PegIFN) remains underdefined. We prospectively evaluated the long-term virological, clinical, and biochemical outcomes, including aspartate aminotransferase-to-platelet ratio index (APRI), in chronic hepatitis C patients with an SVR.Patients and methods We included 145 consecutive, treatment-naive chronic hepatitis C patients (mean age 47.3 +/- 9.1 years; 87 men; 42.1% genotype 1; 36.6% genotype 2/3) who achieved an SVR after combination therapy with PegIFN-/ribavirin.Results The mean follow-up time was 68.8 +/- 35 months. The overall incidence of hepatocellular carcinoma (HCC) and liver-related death was 1.4 and 0.7%, respectively. Among nine (7.6%) patients with pretreatment cirrhosis, two (22.2%) developed HCC and one of them (11.1%) died. No patient had conclusive evidence of late virological relapse. All patients retained normal liver biochemistry, except for five of 145 (3.5%), who had persistently elevated transaminase levels, all of whom were diagnosed with new liver disease. APRI values improved significantly with treatment (0.95 +/- 1.09 vs. 0.66 +/- 0.64, P<0.001) and continued to improve after a mean of 61.4 +/- 45.5 months from an SVR in patients (n=54; 37.2%) with significant (Metavir F2) pretreatment fibrosis (1.13 +/- 0.66 vs. 0.67 +/- 0.45, P<0.001).Conclusion The long-term outcome, including APRI, of chronic hepatitis C patients treated successfully with PegIFN/ribavirin and followed for a mean of 5.7 years is favorable. However, a high risk of progression to HCC and liver-related death remains for patients with pretreatment cirrhosis, in our setting, as high as 22.2 and 11.1%, respectively.

• 出版日期2013-7