Session Title: Category 5g. VIRAL HEPATITIS: g. HEPATITIS C - CLINICAL (THERAPY)
Presentation Date: Apr 15, 2010
SUSTAINED VIROLOGICAL RESPONSE IMPROVES SURVIVAL IN HCV-RELATED LIVER CIRROSIS WITH PORTAL HYPERTENSION
B.E. Annicchiarico1*, M. Siciliano1, A. Iacobellis2, A.W. Avolio3, G. Caracciolo1, A. Andriulli2, G. Bombardieri1
1Internal Medicine, Sacred Heart Catholic University, Roma, 2Gastroenterology, Casa Sollievo della Sofferenza Hospital, Foggia, 3Liver Transplantation Unit, Sacred Heart Catholic University, Roma, Italy. *email@example.com
Development of clinical significant portal hypertension (PH) marks an acceleration of the course of HCV-cirrhosis and a worsening of prognosis. Available data on possible effect of antiviral therapy in modifying the dismal prognosis of patients with more severe PH are scant and contrasting. Our study evaluates the long-term effect of viral eradication on survival of HCV-cirrhotics with PH.
From April 2001 to March 2006, we treated with PEG-IFN α-2b (1.5 µg/Kg/week) and RIBA (>10.6 mg/Kg/day) HCV-cirrhotics with PH satisfying following criteria: age< 65 years, no previous PEG-IFN therapy, bilirubin< 5mg/dL, albumin>2.5g/dL, INR< 1.7, platelets>40000/µl, neutrophils>1000/µl, hemoglobin>11g/dL, creatinine< 1.5mg/dL, no previous hepatic encephalopathy, no previous spontaneous bacterial peritonitis, uncomplicated ascites, no previous gastro-intestinal hemorrhage, CTP score< 12. We treated patients with gastro-esophageal varices at risk of hemorrhage only if under prophylaxis. PH was diagnosed based on platelets< 100.000/µL, spleen diameter>13 cm, gastro-esophageal varices, ascites. Log-rank test was used to compare the cumulative probability of survival. Censoring was defined by assuming that a patient was followed-up for 97 months, liver transplantation, death, or June 30, 2009, whichever came first.
We treated 96 cirrhotics: mean age 57.8; 53 male; 60 genotype 1; 62 naïve; CTP score 5-11(mean 7.2). At baseline 29/96 (30.2%) were decompensated. SVR were obtained in 25 patients (26.0%):22 compensated (32.8%) and 3 decompensated(10.3%) cirrhotics. Serious adverse events occurred in 24 (25.0%) patients: severe cytopenia (2), grade III-hepatic encephalopathy (4), variceal hemorrhage (2), HCC recurrence or new diagnosis (5), refractory ascites (4), spontaneous bacterial peritonitis (1), pulmonary or urinary infection (6). None patient died during therapy. Follow-up from the end of therapy was 3-97 months(mean±SD:39±21). During follow-up:19 patients died (17 liver-related death), 5 were transplanted, 4 were lost. At the end of follow-up 50/68 (73.5%) were decompensated. Long-term cumulative survival was significantly better in presence of SVR respect to non-SVR (Fig.).
Our data suggest that, in front of low virological response and many life-treatening adverse events, viral eradication by PEG-IFN and RBV can significantly ameliorate prognosis in HCV-cirrhotics with PH, making the risk-to-benefit ratio of therapy more favorable in these patients.