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A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C
Author(s) -
Dienstag Jules L.,
Ghany Marc G.,
Morgan Timothy R.,
Di Bisceglie Adrian M.,
Bonkovsky Herbert L.,
Kim HaeYoung,
Seeff Leonard B.,
Szabo Gyongyi,
Wright Elizabeth C.,
Sterling Richard K.,
Everson Gregory T.,
Lindsay Karen L.,
Lee William M.,
Lok Anna S.,
Morishima Chihiro,
Stoddard Anne M.,
Everhart James E.
Publication year - 2011
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24370
Subject(s) - medicine , cirrhosis , gastroenterology , ribavirin , hepatocellular carcinoma , hepatitis c , liver disease , liver transplantation , fibrosis , hepatitis c virus , transplantation , immunology , virus
The incidence of liver disease progression among subjects with histologically advanced but compensated chronic hepatitis C is incomplete. The Hepatitis C Antiviral Long‐term Treatment against Cirrhosis Trial was a randomized study of 3.5 years of maintenance peginterferon treatment on liver disease progression among patients who had not cleared virus on peginterferon and ribavirin therapy. Patients were followed subsequently off therapy. Because maintenance peginterferon treatment did not alter liver disease progression, we analyzed treated and control patients together. Among 1,050 subjects (60% advanced fibrosis, 40% cirrhosis), we determined the rate of progression to cirrhosis over 4 years and of clinical outcomes over 8 years. Among patients with fibrosis, the incidence of cirrhosis was 9.9% per year. Six hundred seventy‐nine clinical outcomes occurred among 329 subjects. Initial clinical outcomes occurred more frequently among subjects with cirrhosis (7.5% per year) than subjects with fibrosis (3.3% per year) ( P < 0.0001). Child‐Turcotte‐Pugh (CTP) score ≥7 was the most common first outcome, followed by hepatocellular carcinoma. Following occurrence of a CTP score ≥7, the rate of subsequent events increased to 12.9% per year, including a death rate of 10% per year. Age and sex did not influence outcome rates. Baseline platelet count was a strong predictor of all clinical outcomes. During the 8 years of follow‐up, death or liver transplantation occurred among 12.2% of patients with advanced fibrosis and 31.5% of those with cirrhosis. Conclusion: Among patients with advanced hepatitis C who failed peginterferon and ribavirin therapy, the rate of liver‐related outcomes, including death and liver transplantation, is high, especially once the CTP score reaches at least 7. (H EPATOLOGY 2011)