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Panminerva Medica 2003 September;45(3):175-82


language: English

The impact of antiviral therapy on the course of chronic HCV infection. A systematic review

Almasio P. L., Venezia G., Craxì A.

Unit of Gastroenterology, University of Palermo, Palermo, Italy


Aim. Chronic hep­a­titis C is a pro­gres­sive dis­ease ­that ­leads to liv­er cir­rho­sis and hepat­o­cel­lu­lar car­ci­no­ma in a peri­od rang­ing ­from 10 to 30 ­y. Many fac­tors ­have ­been relat­ed to dis­ease pro­gres­sion and, ­among ­them, per­sis­tent HCV rep­li­ca­tion has ­been advo­cat­ed as one of the ­major deter­mi­nant of hepat­ic dete­ri­ora­tion. With ­this ­respect any treat­ment of chron­ic hep­a­titis C is main­ly ­aimed to ­reduce ­necro-inflam­ma­tion by sup­press­ing ­viral activ­ity in the ­long-­term.
We eval­u­at­ed the per­sis­tence of HCV clear­ance ­after inter­fer­on ther­a­py dur­ing fol­low-up in ­patients con­sid­ered as ­long-­term respond­ers. Secondly, we ana­lyzed the ­rate of pro­gres­sion ­from hep­a­titis to cir­rho­sis and hepat­o­cel­lu­lar car­ci­no­ma in ­patients ­with per­sis­tent ­viral elim­i­na­tion as com­pared to ­those who did not ­respond to treat­ment.
Methods. We per­formed a system­at­ic ­review of pub­lished ­data as ­full ­papers on treat­ment of chron­ic hep­a­titis ­that report­ed ­data on ­long-­term fol­low-up of ­patients ­with per­sis­tent HCV sup­pres­sion and the ­rate of cir­rho­sis and hepat­o­cel­lu­lar car­ci­no­ma in ­long-­term respond­ers as com­pared to non-respond­ers. Data ­were ­pooled to ­obtain a com­bined esti­mate of the ­reduced rel­a­tive ­risk ­using the ran­dom ­effect mod­el.
Results. In ­patients achiev­ing a sus­tained vir­o­log­i­cal ­response a ­relapse was ­observed in ­about 13% (­range 0-86%). In sub­jects ­with a sus­tained ­viral ­response pro­gres­sion to cir­rho­sis is uncom­mon. When com­pared to relaps­ers or non-respond­ers the cal­cu­lat­ed ­risk reduc­tion in ­this ­group was -0.22 (95% C.I. - 0.36/-0.08). The cal­cu­lat­ed esti­mates of ­risk reduc­tion of devel­op­ing hepat­o­cel­lu­lar car­ci­no­ma in ­patients ­achieved sus­tained ­response ­were -0.097 (95% C.I. -0.13/-0.07).
Conclusion. There is a ­high ­chance ­that ­patients in remis­sion dur­ing the ­first 6 ­mo ­after anti­vi­ral treat­ment ­will ­remain so for the ­rest of ­their ­life. Cumulative ­data ­from lit­er­a­ture ­showed a sig­nif­i­cant reduc­tion in the ­rate of pro­gres­sion to cir­rho­sis and devel­op­ment of hepat­o­cel­lu­lar car­ci­no­ma in sus­tained ­viral respond­ers as com­pared to non-respond­ers or relaps­ers. However, ­since fac­tors pre­dic­tive of sus­tained ­response to inter­fer­on are inde­pen­dent­ly asso­ciat­ed ­with ­less fre­quent and/or lat­er devel­op­ment of decom­pen­sa­tion or HCC, the ben­e­fi­cial ­effects of anti­vi­ral ther­a­py may be prob­ably over­es­ti­mat­ed.

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