Effects of interferon treatment response on liver complications of chronic hepatitis C: 9-year follow-up study

被引:48
作者
Coverdale, SA
Khan, MH
Byth, K
Lin, R
Weltman, M
George, J
Samarasinghe, D
Liddle, C
Kench, JG
Crewe, E
Farrell, GC
机构
[1] Westmead Millennium Inst, Storr Liver Unit, Westmead, NSW 2145, Australia
[2] Univ Sydney, Westmead Hosp, Div Med, Dept Anat Pathol, Westmead, NSW 2145, Australia
[3] ICPMR, Dept Virol, Hepatatis Lab, Westmead, NSW 2145, Australia
关键词
D O I
10.1111/j.1572-0241.2004.04085.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
OBJECTIVES: Fibrotic severity, biochemical indices of poor liver function, and sporadic transmission are independent predictors of liver complications among people with chronic hepatitis C. After accounting for these factors, we tested whether interferon treatment or the treatment response reduces the rate of liver cancer, liver-related death or transplantation, and other liver complications during extended follow-up. METHODS: Liver clinic cohort of 455 patients with histologically proven chronic hepatitis C was followed prospectively for median 9 yr (IQ 6, 11 yr); 384 received interferon, 343 completed a treatment course. Liver complications were assessed in relation to treatment and treatment response in univariate and multivariate models, and survival to onset of liver-related complications was determined. RESULTS: The annual incidence of total liver complications was 1.5% in treated and 2.9% in untreated patients and appeared quasilinear throughout 9-yr follow-up. Interferon treatment did not influence the rate of liver complications. However, the rate of complications increased exponentially with transition of the treatment response from sustained viral response (SVR), through response-relapse to nonresponse (or no treatment). By univariate analysis, response to interferon treatment was a significant predictor of complications. After adjustment for fibrosis score, serum albumin concentration and mode of transmission in a multivariate model, treatment response just failed to reach significance (p = 0.058) as a predictor of outcome. CONCLUSIONS: Response to antiviral therapy, and particularly SVR, appears to reduce liver complications in chronic hepatitis C. However, in the absence of an antiviral treatment response, a course of interferon does not reduce risks of liver cancer or liver failure.
引用
收藏
页码:636 / 644
页数:9
相关论文
共 44 条
  • [1] Patterns of hepatocellular carcinoma development in hepatitis B virus and hepatitis C virus related cirrhosis
    Benvegnù, L
    Alberti, A
    [J]. ANTIVIRAL RESEARCH, 2001, 52 (02) : 199 - 207
  • [2] Brunetto MR, 1998, LANCET, V351, P1535
  • [3] Long-term course of interferon-treated chronic hepatitis C
    Cammà, C
    Di Marco, V
    Lo Iacono, O
    Almasio, P
    Giunta, M
    Fuschi, P
    Vaccaro, A
    Fabiano, C
    Magrin, S
    Di Stefano, R
    Bonura, C
    Pagliaro, L
    Craxì, A
    [J]. JOURNAL OF HEPATOLOGY, 1998, 28 (04) : 531 - 537
  • [4] Interferon and prevention of hepatocellular carcinoma in viral cirrhosis:: an evidence-based approach
    Cammà, C
    Giunta, M
    Andreone, P
    Craxì, A
    [J]. JOURNAL OF HEPATOLOGY, 2001, 34 (04) : 593 - 602
  • [5] Cooksley WGE, 1997, J VIRAL HEPATITIS, V4, P317
  • [6] Changes in liver fibrosis at the end of alpha interferon therapy and 6 to 18 months later in patients with chronic hepatitis C: quantitative assessment by a morphometric method
    Duchatelle, V
    Marcellin, P
    Giostra, E
    Bregeaud, L
    Pouteau, M
    Boyer, N
    Auperin, A
    Guerret, S
    Erlinger, S
    Henin, D
    Degott, C
    [J]. JOURNAL OF HEPATOLOGY, 1998, 29 (01) : 20 - 28
  • [7] Risk factors for development of hepatocellular carcinoma among Australians with hepatitis C: a case-control study
    Dutta, U
    Byth, K
    Kench, J
    Khan, MH
    Coverdale, SA
    Weltman, M
    Lin, R
    Liddle, C
    Farrell, GC
    [J]. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1999, 29 (03): : 300 - 307
  • [8] Hepatocellular carcinoma after sustained response to interferon in non-cirrhotic hepatitis C: Flaws in the cure, or a clue to the flaws?
    Farrell, GC
    [J]. JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 1999, 14 (09) : 833 - 837
  • [9] Lymphoblastoid interferon Alfa-n1 improves the long-term response to a 6-month course of treatment in chronic hepatitis C compared with recombinant interferon Alfa-2b: Results of an international randomized controlled trial
    Farrell, GC
    Bacon, BR
    Goldin, RD
    [J]. HEPATOLOGY, 1998, 27 (04) : 1121 - 1127
  • [10] JGH and Asia-Pacific consensus on prevention and management of gastrointestinal and liver diseases
    Farrell, GC
    Liaw, YF
    McCaughan, GW
    [J]. JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2000, 15 (08) : 815 - 818