Cirrhosis, high age and high body mass index are risk factors for persisting advanced fibrosis after sustained virologic response in chronic hepatitis C

2018 Journal of viral hepatitis In Press;

We aimed to assess fibrosis with liver stiffness measurement long-term after sustained virologic response of chronic hepatitis C, and to identify risk factors associated with persisting fibrosis. In this cross-sectional study, patients with chronic hepatitis C and pre-treatment advanced fibrosis or cirrhosis treated successfully at Karolinska University Hospital with an interferon-containing regimen, underwent liver stiffness measurement with FibroScan. The impact of potential risk factors for persisting fibrosis was estimated. We included 269 patients with a median follow-up time of 7.7 years (range 0-20), 84 with a follow-up time of >/= 10 years. Patients with pre-treatment cirrhosis had a significantly higher median liver stiffness level (8.5 kPa 95% CI 7-9.1) at follow-up, than patients with advanced fibrosis (6 kPa 95% CI 5.5-6.4). A majority improved their fibrosis stage after sustained virologic response, but 24% had persisting advanced fibrosis with a liver stiffness level of >/= 9.5 kPa. Among patients with pre-treatment cirrhosis the proportion with persisting advanced fibrosis diminished with longer follow-up time, from 48% after 10 years. The main risk factors for persisting advanced fibrosis were pre-treatment cirrhosis, high age and body mass index. In conclusion, fibrosis improves substantially during long-term follow-up after sustained virologic response in hepatitis C patients with pre-treatment advanced liver fibrosis. Life-style intervention to decrease weight in obese persons and treatment before establishment of cirrhosis should therefore be recommended to avoid persistence of advanced fibrosis after virologic cure. This article is protected by copyright. All rights reserved.

Pubmed : 29406590