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Sustained virological response: A milestone in the treatment of chronic hepatitis C

World Journal of Gastroenterology 2013年第18期19卷 2793-2798页

作者： Filomena Morisco Rocco Granata Tommaso Stroffolini Maria Guarino laura Donnarumma laura gaeta Ilaria Loperto Ivan Gentile Francesco Auriemma Nicola Caporaso Dipartimento di Medicina Clinica e Chirurgia Gastroenterology Unit University of Naples "Federico Ⅱ" 80131 Naples Italy Dipartimento di Malattie Infettive e Tropicali University of Rome "La Sapienza" 00161 Rome Italy Dipartimento di Medicina Clinica e Chirurgia Infectious Diseases Unit University of Naples "Federico Ⅱ" 80131 Naples Italy

AIM: To evaluate the long-term eradication of hepatitis C virus (HCV) infection and liver-related complications in chronically infected patients that have achieved sustained virological response. METHODS: One hundred and fifty subjects with chronic hepatitis C (CHC) or cirrhosis and sustained virological response (SVR) between the years of 1989 and 2008 were enrolled in a long-term clinical follow-up study at the Gastrointestinal and Liver Unit of the University Hospital of Naples "Federico Ⅱ". At the beginning of the study, the diagnosis of HCV infection was made on the basis of serum positivity for antibodies to HCV and detection of HCV RNA transcripts, while a diagnosis of chronic hepatitis was formulated using imaging techniques and/or a liver biopsy. SVR was achieved by interferon-based therapy, both conventional and pegylated, with and without ribavirin treatment. The patients were evaluated for follow-up at a median length of 8.6 years, but ranged from 2-19.9 years. Among them, 137 patients had pre-treatment CHC and 13 had cirrhosis. The patients were followed with clinical, biochemical, virological, and ultrasound assessments on a given schedule. Finally, a group of 27 patients underwent a liver biopsy at the beginning of the study and transient elastography at their final visit to evaluate changes in liver fibrosis. RESULTS: The median follow-up was 8.6 years (range 2-19.9 years). HCV RNA remained undetectable in all patients, even in patients who eventually developed liver-related complications, indicating no risk of HCV recurrence. Three liver-related complications were observed: two cases of hepatocellular carcinoma and one case of bleeding from esophageal varices resulting in an incidence rate of 0.23%/person per year. Further, all three complications took place in patients diagnosed with cirrhosis before treatment began. Only one death due to liver-related causes occurred, resulting in a mortality rate of 0.077% person per year. This amounts to a 99.33

关键词： Antiviral therapy Cirrhosis Hepatitis C virus Sustained virological response Fibrosis

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