Eradication of Hepatitis C Virus in Patients Successfully Treated for Chronic Hepatitis C

doi:10.1053/j.gastro.2008.05.044

Gastroenterology

Volume 135, Issue 3, September 2008, Pages 821-829

https://doi.org/10.1053/j.gastro.2008.05.044 Get rights and content

Background & Aims: It is unclear whether hepatitis C virus (HCV) is eradicated in patients with chronic hepatitis C who achieved a sustained virologic response (SVR). Methods: In this long-term follow-up study, including chronic hepatitis C patients who achieved SVR after interferon-based therapy, the presence of residual HCV RNA in serum, liver, and peripheral blood mononuclear cells (PBMCs) was assessed, using transcription-mediated amplification (sensitivity, <9.6 IU/mL). The benefit of SVR on liver fibrosis was evaluated using the METAVIR score. Results: A total of 344 patients were followed up for a median duration of 3.27 years (range, 0.50–18 y; interquartile range [IQR], 1.68–5.35 y). A total of 114 patients had a posttreatment liver tissue (median, 0.50 y; range, 0–14 y; IQR, 0–3.5 y) and a total of 156 had one PBMC (median, 3.0 y; range, 0.50–18 y; IQR, 1.25–5.50 y). Serum HCV RNA remained undetectable (1300 samples), indicating that none of the patients had a relapse. HCV RNA was detectable in 2 of 114 (1.7%) liver specimens, and in none of 156 PBMC specimens. Histologic analysis of 126 paired pretreatment and posttreatment liver biopsy specimens (median, 0.50 y; range, 0–14 y; IQR, 0–3.5 y) showed that fibrosis stage was improved in 56%, stable in 32%, deteriorated in 12%. Regression of cirrhosis was observed in 9 of 14 (64%) (95% confidence interval, 39–89) patients. No cirrhosis decompensation was observed, and 3 patients developed hepatocellular carcinoma. Conclusions: In this large cohort of chronic hepatitis C patients, SVR was durable up to 18 years after treatment cessation, in addition to fibrosis stability/improvement (88%) and cirrhosis regression (64%). The presence of residual HCV RNA was observed only in liver tissue (1.7%). This result strongly suggests that SVR may be considered to show eradication of HCV infection.

Section snippets

Patients and Study Design

Between January 1988 and January 2005, 550 patients who achieved an SVR were included in our data base and were followed up in our center. From January 2005 to June 2006, 344 of these 550 patients seen at our outpatient clinic for a follow-up visit were included in the analysis.

IFN or PEG-IFN was administered either as monotherapy or in combination with ribavirin, according to body weight. Chronic hepatitis C was defined as the presence of anti-HCV antibodies (Ortho HCV Diagnostic System,

Patients

The demographic, clinical, virologic, and histologic characteristics, and the treatment regimens of the 344 patients included and the 206 patients not included are shown in Table 1. The 2 groups of patients were similar according to all the baseline characteristics excepted for the median duration of the follow-up evaluation, which was 3.27 years (range, 0.50–18 y; IQR, 1.68–5.35 y) and 1.26 years (range, 0.50–16 y; IQR, 0.66–3.27 y) in included and nonincluded patients, respectively (P = .002)

Discussion

Our study, investigating the presence of residual HCV RNA with a sensitive assay (TMA) in serum, liver, and PBMCs, together with a histologic follow-up evaluation in a large cohort, confirms an association between sustained biochemical and virologic responses and liver histologic improvements in patients with an SVR to IFN-based therapy. None of the 344 patients included had a relapse during the long-term follow-up evaluation (median, 3.27 y; range, 0.50–18 y; IQR, 1.68–5.35 y). HCV RNA was

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Clinical–Liver, Pancreas, and Biliary TractEradication of Hepatitis C Virus in Patients Successfully Treated for Chronic Hepatitis C

Section snippets

Patients and Study Design

Patients

Discussion

Lancet

Hepatology

Lancet

J Hepatol

Hepatology

Gastroenterology

Blood

Hepatology

Am J Gastroenterol

J Clin Virol

Hepatology

J Hepatol

Gastroenterology

Management of hepatitis C: 2002

Treatment of hepatitis CThe 2002 French consensus

Gut

Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C

N Engl J Med

Peginterferon alfa-2a in patients with chronic hepatitis C

N Engl J Med

Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis

N Engl J Med

Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection

N Engl J Med

Peginterferon-a2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose

Ann Intern Med

Clinical–Liver, Pancreas, and Biliary Tract
Eradication of Hepatitis C Virus in Patients Successfully Treated for Chronic Hepatitis C