Antiviral treatment and long-term clinical outcome of decompensated cirrhotic patients with hepatitis C virus infection.
- Author:
Fanpu JI
1
;
Shuangsuo DANG
;
Zhifang CAI
;
Hongan XUE
;
Na HUANG
;
Layang LIU
;
Shu ZHANG
;
Yonghong GUO
;
Xiaoli JIA
;
Yuan WANG
;
Zongfang LI
;
Hong DENG
Author Information
- Publication Type:Journal Article
- MeSH: Alanine Transaminase; Antiviral Agents; therapeutic use; Carcinoma, Hepatocellular; Drug Therapy, Combination; Genotype; Hepacivirus; genetics; Hepatitis C; diagnosis; drug therapy; Humans; Interferon-alpha; therapeutic use; Kaplan-Meier Estimate; Liver Cirrhosis; drug therapy; virology; Liver Neoplasms; Polyethylene Glycols; therapeutic use; Prospective Studies; Recombinant Proteins; therapeutic use; Ribavirin; therapeutic use; Treatment Outcome
- From: Chinese Journal of Hepatology 2015;23(9):647-652
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo investigate the efficacy and safety of antiviral treatment in patients with hepatitis C virus (HCV) infection and decompensated cirrhosis and determine the effects of virological response on long-term prognosis.
METHODSSixty-six consecutive,interferon (IFN)-na(i)ve patients with HCV infection and decompensated cirrhosis were enrolled in this prospective study. All patients were given a 48-to 72-week course of IFN plus ribavirin (RBV) combined therapy,with a low accelerating dosage regimen using either:pegylated (PEG)-IFNa-2b at 1.0-1.5 mug/kg/week,PEG-IFNa-2a at 90-180 mug,or standard IFN-a-2b at 3MU,every other day.RBV was given at 800 to 1000 mg/day. All patients were routinely monitored for adverse drug reactions and virological response.Effects of treatments on patient survival were assessed by Kaplan-Meier analysis.
RESULTSAt the end of treatment,74.2% of patients were HCV RNA-negative,with 45.5% having achieved sustained virological response and 28.8% having relapsed;the remaining 25.7% of patients showed non-virological response (NVR). Among the patients with HCV genotype 1, 65.9% achieved end-of-treatment virological response (ETVR) and 34.1% achieved SVR;among the patients with HCV genotype 2,90.9% achieved ETVR and 68.2% achieved SVR. The positive and negative predictive values of early virological response (EVR) for ETVR were 95.7% and 75.0% respectively, and for SVR were 65.2% and 100% respectively. Compared with baseline,patients who achieved ETVR had better liver function,as evidenced by changes in levels of total bilirubin,alanine aminotransferase and albumin,as well as prothrombin activity and Child-Pugh score (t =4.564,11.486,2.303,2.699,3.694 respectively, all P less than 0.05).Compared with the NVR patients, the ETVR patients had lower risk of hepatic decompensation and hepatocellular carcinoma, and had improved survival (x2=18.756,6.992,7.580, respectively, all P less than 0.05).Twelve (18.2%) patients experienced serious adverse events,with 10 requiring premature treatment withdrawal and 2 dying.
CONCLUSIONAntiviral treatment for patients with HCV infection and decompensated cirrhosis using interferon in a low accelerating dosage regimen in combination with ribavirin is feasible.Patients who achieved ETVR had significantly improved long-term prognosis.
