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Minerva Medica 2019 October;110(5):401-9

DOI: 10.23736/S0026-4806.19.06108-1


lingua: Inglese

Clinical outcomes in chronic hepatitis C long-term responders to pre-direct antiviral agents: a single-center retrospective study

Chiara ROSSO 1 , Gian Paolo CAVIGLIA 1, Michela CIRUOLO 1, Alessia CIANCIO 1, Ramy YOUNES 1, Antonella OLIVERO 1, Chiara GIORDANINO 2, Giulia TROSHINA 1, Maria Lorena ABATE 1, Mario RIZZETTO 1, Rinaldo PELLICANO 2, Giorgio M. SARACCO 1, Elisabetta BUGIANESI 1, Antonina SMEDILE 1

1 Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy; 2 Department of Gastro-Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy

BACKGROUND: Obesity, type 2 diabetes (T2D), dyslipidemia, arterial hypertension as well as hepatic steatosis (HS) are common conditions that can affect clinical outcomes of patients with chronic hepatitis C (CHC) who achieved sustained virologic response (SVR). The aim of this study was to assess the impact of metabolic cofactors on the occurrence of clinical events during follow-up (FU) in a group of CHC long-term responders (LTRs) to interferon- (IFN) based therapy.
METHODS: A total of 5172 medical records of CHC patients enrolled from 1990 to 2011 were examined; 1034 of 5172 (20%) patients were treated with IFN-based therapy and 382 of 1034 (37%) of them achieved SVR. A total of 188 (49%) LTRs underwent liver biopsy before antiviral treatment. Data on liver and cardiometabolic events such as cirrhosis and its complications, hepatocellular carcinoma, coronary artery disease, arterial hypertension, impaired fasting glucose (IFG)/type 2 diabetes (T2D) and dyslipidemia, were collected over time.
RESULTS: The mean age of the whole cohort was 46±12 years and 114/188 (61%) patients were males. HS was found in 82 of 188 (43.6%) patients and most of them were infected by HCV genotype 3a. The prevalence of obesity, IFG/T2D, dyslipidemia and arterial hypertension was 4.3%, 6.9%, 37.2%, and 5.9%, and was similarly distributed among patients with and without HS. Cirrhosis was histologically diagnosed in 18 of 188 (9.6%) patients. After a median follow-up of 11 years (range 3-21 years), the cumulative incidence of cardiovascular events, IFG/T2D and dyslipidemia was higher in CHC-LTRs who had HS at baseline compared to those without HS (1.2%, 2.3%, and 3.0% vs. 0.4%, 0.8%, and 2.5%, respectively). At multivariable Cox regression analysis, HS was significantly associated to the development of cardiovascular events and IFG/T2D (HR=5.2, 95% CI: 1.3-20.7, P=0.019, and HR=2.6, 95% CI: 1.1-6.2, P=0.027, respectively).
CONCLUSIONS: In CHC-LTRs, HS at baseline may predispose to the development of cardiovascular events and T2D during follow-up emphasizing the importance of an accurate counseling in order to prevent extra-hepatic complications.

KEY WORDS: Hepacivirus; Enzyme activation; Metabolism; Fatty liver

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