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The assessment of individual risk of fibrosis progression in patients with chronic hepatitis C is an unmet clinical need. Recent genome-wide association studies have highlighted several genetic alterations as predictive risk factors of rapid fibrosis progression in chronic hepatitis C. However, most of these results require verification, and whether the combined use of these genetic predictors can assess the risk of fibrosis progression remains unclear. Therefore, genetic risk factors associated with fibrosis progression were analyzed in 176 chronic hepatitis C patients who did not achieve sustained virological response by interferon-based therapy and linked to the fibrosis progression rate (FPR). FPR was determined in all patients by paired liver biopsy performed before and after therapy (mean interval: 6.2 years). Mean FPR in patients with  IL28B  (rs8099917) TG/GG and  PNPLA3  (rs738409) CG/GG were significantly higher than in those with  IL28B  TT (FPR: 0.144 vs. 0.034,  P  < 0.001) and  PNPLA3  CC (FPR: 0.10 vs. 0.018,  P  = 0.005), respectively.  IL28B  TG/GG [hazard ratio (HR): 3.9,  P  = 0.001] and  PNPLA3  CG/GG (HR: 3.1,  P  = 0.04) remained independent predictors of rapid fibrosis progression upon multivariate analysis together with average alanine aminotransferase after interferon therapy ≥40 IU/l (HR: 4.2,  P  = 0.002). Based on these data, we developed a new clinical score predicting the risk of fibrosis progression (FPR-score). The FPR-score identified subgroups of patients with a low (FPR: 0.005), intermediate (FPR: 0.103,  P  < 0.001), and high (FPR: 0.197,  P  < 0.001) risk of fibrosis progression. In conclusion,  IL28B  and  PNPLA3  genotypes are associated with rapid fibrosis progression, and the FPR-score identifies patients who has a high risk of fibrosis progression and require urgent antiviral treatment.

plos one

Genetic Polymorphisms of IL28B and PNPLA3 Are Predictive for HCV Related Rapid Fibrosis Progression and Identify Patients Who Require Urgent Antiviral Treatment with New Regimens