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    Sustained virological response halts fibrosis progression: A long-term follow-up study of people with chronic hepatitis C infection

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    Author
    Mei, SLGCY; Thompson, AJ; Christensen, B; Cunningham, G; McDonald, L; Bell, S; Iser, D; Nguyen, T; Desmond, PV
    Date
    2017-10-24
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Desmond, Paul; Thompson, Alexander; Bell, Sally
    Affiliation
    Medicine and Radiology
    Medical Education
    Metadata
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    Document Type
    Journal Article
    Citations
    Mei, S. L. G. C. Y., Thompson, A. J., Christensen, B., Cunningham, G., McDonald, L., Bell, S., Iser, D., Nguyen, T. & Desmond, P. V. (2017). Sustained virological response halts fibrosis progression: A long-term follow-up study of people with chronic hepatitis C infection. PLOS ONE, 12 (10), https://doi.org/10.1371/journal.pone.0185609.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/257414
    DOI
    10.1371/journal.pone.0185609
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655473
    Abstract
    BACKGROUND/AIMS: Long-term follow-up studies validating the clinical benefit of sustained virological response (SVR) in people with chronic hepatitis C (CHC) infection are lacking. Our aim was to identify rates and predictors of liver fibrosis progression in a large, well characterized cohort of CHC patients in whom paired liver fibrosis assessments were performed more than 10 years apart. METHODS: CHC patients who had undergone a baseline liver biopsy pre-2004 and a follow up liver fibrosis assessment more than 10 years later (biopsy or liver stiffness measurement (LSM) using transient elastography [FibroScan]) were identified. Subjects who had undergone a baseline liver biopsy but had no follow up fibrosis assessment were recalled for LSM. Fibrosis was categorised as mild-moderate (METAVIR F0-2 / LSM result of ≤ 9.5 kPa) or advanced (METAVIR F3-4/ LSM >9.5 kPa). The primary objective was to assess the association between SVR and the rate of liver fibrosis progression over at least 10 years, defined as an increase from mild-moderate fibrosis at baseline liver biopsy (METAVIR F0-2) to advanced fibrosis at follow-up liver fibrosis assessment. RESULTS: 131 subjects were included in this analysis: 69% male, 82% Caucasian, 60% G1 HCV, 25% G3 HCV. The median age at F/U fibrosis staging was 57 (IQR 54-62) years with median estimated duration of infection 33-years (IQR 29-38). At F/U, liver fibrosis assessment was performed by LSM in 86% and liver biopsy in 14%. The median period between fibrosis assessments was 14-years (IQR 12-17). 109 (83%) participants had received interferon-based antiviral therapy. 40% attained SVR. At F/U, there was a significant increase in the proportion of subjects with advanced liver fibrosis: 27% at baseline vs. 46% at F/U (p = 0.002). The prevalence of advanced fibrosis did not change among subjects who attained SVR, 30% at B/L vs 25% at F/U (p = 0.343). However, advanced fibrosis became more common at F/U among subjects with persistent viremia: 10% at B/L vs 31% at F/U (p = 0.0001). SVR was independently associated with protection from liver fibrosis progression after adjustment for other variables including baseline ALT (p = 0.011), duration of HCV infection and mode of acquisition. CONCLUSION: HCV eradication is associated with lower rates of liver fibrosis progression. The data support early treatment to prevent long-term liver complications of HCV infection.

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