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Although the short-term benefits of a sustained virological response to interferon-based therapies of chronic hepatitis C are well known, the long-term consequences of sustained virological response are less clear.
Dr Koh and colleagues from Maryland, USA assessed changes in markers of disease activity and fibrosis in patients followed up to 23 years post-sustained virological response.
The first 103 sustained virological response patients at the National Institutes of Health Clinical Center were evaluated. Serum markers before treatment and at the last visit were compared. Evaluations after 2007 included transient elastography.  | | Transient elastography was cirrhotic range in 9% | | Alimentary Pharmacology & Therapeutics |
Of 103 patients, 3 subsequently relapsed 0.7, 6.3 and 6.5 years post therapy. The remaining 100 patients maintained sustained virological response at final follow-up. No patients developed hepatic decompensation, but one with pre-treatment cirrhosis died 12 years post sustained virological response of hepatocellular carcinoma. In comparison to pre-treatment values, markers improved at follow-up, including mean ALT, AST, alkaline phosphatase, IgG, platelet count, and AST to platelet count ratio index. The team performed transient elastography in 69 patients and was normal in 60%, moderately elevated in 31% and cirrhotic range in 9%. Transient elastography and platelet counts at follow-up correlated with fibrosis on pre-treatment liver biopsy.
Dr Koh's team concluded, "In 97% of patients with chronic hepatitis C, sustained virological response is durable without evidence of disease progression, although some degree of hepatic fibrosis may persist and patients with pre-treatment cirrhosis are at continuing low risk for hepatocellular carcinoma."
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