Original article—liver, pancreas, and biliary tractPortal Pressure Predicts Outcome and Safety of Antiviral Therapy in Cirrhotic Patients With Hepatitis C Virus Infection
Section snippets
Patients
After exclusion of Child–Pugh B/C patients, 133 consecutive patients with histologically proven (n = 121; 91%) or clinically evident (n = 12; 9%) cirrhosis as a result of chronic HCV infection were prospectively included during the study period (2006–2010). Before initiation of antiviral therapy, all patients were screened for portal hypertension. Upper gastrointestinal endoscopy was performed to screen for gastroesophageal varices,20 and portal pressure was measured by HVPG. Patients with
Patient Characteristics
During the 4-year study period, 133 patients with suspected cirrhosis as a result of chronic HCV infection were evaluated for antiviral therapy; patient characteristics are listed in Table 1. Eight patients undergoing HVPG measurement together with transjugular biopsy did not show cirrhosis in liver histology. Seventeen patients with cirrhosis in liver biopsy did not consent to undergo HVPG measurement. Eighteen patients had both liver biopsy and measurement of HVPG, but did not start antiviral
Discussion
Our data confirmed that antiviral therapy is generally less effective in cirrhotic HCV patients, but showed a clear difference in cirrhotic patients with or without portal hypertension (objectively diagnosed by HVPG). This study reveals that measurement of HVPG before starting antiviral therapy provides clinically relevant information because SVR rates were significantly worse in patients with CSPH (HVPG ≥10 mm Hg) than in patients without (14% vs 51%). Current guidelines are based on studies
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2016, Digestive and Liver DiseaseCitation Excerpt :Measurement of HVPG prior to antiviral therapy provides important predictive information with respect to treatment response and safety parameters in patients with HCV related liver cirrhosis. Virological response to peg-IFN and RBV therapy is worse in cirrhotics with significant portal hypertension [7,29]. However, HVPG measurement is not commonly available and an invasive and cost expensive procedure.
Measurement of portal pressure
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Conflicts of interest The authors disclose no conflicts.
Funding This study was supported by a grant from MSD (former AescaPharma) Austria and a grant from Roche Austria to MP-R.