Portal Pressure Predicts Outcome and Safety of Antiviral Therapy in Cirrhotic Patients with HCV infection

2011 Clinical Gastroenterology & Hepatology 9;7 (602-608 e 601)

BACKGOURND & AIMS: There are limited data on the efficacy and safety of antiviral therapy in patients with hepatitis C virus (HCV)-related cirrhosis, particularly on the impact of portal hypertension. METHODS: We assessed hepatovenous pressure gradient (HVPG), liver stiffness (transient elastography), and IL28B polymorphisms (rs12979860) in 90 cirrhotic patients with HCV infection (82% genotype 1 or 4) before antiviral therapy with pegylated interferon and ribavirin. Efficacy and safety were evaluated. RESULTS: Rates of sustained virologic response (SVR) were significantly lower among patients with clinically significant portal hypertension (CSPH; HVPG>/=10mmHg;n=50) than among patients without CSPH (HVPG80% of planned dose (P=0.647). The predictive value of HVPG (area under the curve [AUC]:0.743) was greater than that of liver stiffness (AUC:0.647) or of baseline HCV-RNA levels (AUC:0.620). The IL28B polymorphism was not significantly associated with a SVR. Multivariate analysis revealed that HVPG (odds ratio [OR]:14.3;P=0.009), baseline HCV-RNA levels (OR:5.3;P=0.019) and HCV genotype (OR:6.5;P=0.046) were independent risk factors for treatment failure. A trend towards higher incidence of anemia and neutropenia was observed for patients with CSPH. The incidence and grade of thrombocytopenia were significantly higher among patients with than without CSPH (94% vs. 75%;P=0.006). CONCLUSION: HVPG is an independent predictor of response to antiviral therapy, with better predictive value than liver stiffness, baseline HCV-RNA levels, HCV genotype, or IL28B polymorphism. The incidence and grade of thrombocytopenia during antiviral therapy are higher among patients with CSPH. In evaluating cirrhotic HCV patients for antiviral treatment, measurement of HVPG should be considered.