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Quantitative tests of liver function measure hepatic improvement after sustained virological response: results from the HALT‐C trial
Author(s) -
EVERSON G. T.,
SHIFFMAN M. L.,
HOEFS J. C.,
MORGAN T. R.,
STERLING R. K.,
WAGNER D. A.,
DESANTO J. L.,
CURTO T. M.,
WRIGHT E. C.
Publication year - 2009
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2008.03908.x
Subject(s) - medicine , gastroenterology , cirrhosis , liver function , liver function tests , ribavirin , hepatitis c , renal function , hepatitis c virus , immunology , virus
Summary Backgroud The impact of virologic response on hepatic function has not been previously defined. Aim To determine the relationships of quantitative liver function tests (QLFTs) with virological responses to peginterferon (PEG) ± ribavirin (RBV) in patients with chronic hepatitis C and to use serial QLFTs to define the spectrum of hepatic improvement after sustained virological response (SVR). Methods Participants ( n = 232) were enrolled in the Hepatitis C Antiviral Long‐term Treatment against Cirrhosis (HALT‐C) Trial, had failed prior therapy, had bridging fibrosis or cirrhosis and were retreated with PEG/RBV. All 232 patients had baseline QLFTs; 24 patients with SVR and 68 nonresponders had serial QLFTs. Lidocaine, [24‐ 13 C]cholate, galactose and 99m Tc‐sulfur colloid were administered intravenously; [2,2,4,2‐ 2 H]cholate, [1‐ 13 C]methionine, caffeine and antipyrine were administered orally. Clearances ( Cl ), breath 13 CO 2 , monoethylglycylxylidide (MEGX), perfused hepatic mass (PHM) and liver volume were measured. Results Rates of SVR were 18–26% in patients with good function by QLFTs, but ≤6% in patients with poor function. Hepatic metabolism, measured by caffeine k elim ( P = 0.02), antipyrine k elim ( P = 0.05) and antipyrine Cl ( P = 0.02) and the portal circulation, measured by cholate Cl oral ( P = 0.0002) and cholate shunt ( P = 0.0003) and PHM ( P = 0.03) improved after SVR. Conclusion Hepatic dysfunction impairs the virological response to PEG/RBV. SVR improves hepatic metabolism, the portal circulation and PHM.