In a new study, patients with chronic hepatitis C virus infection who achieved a sustained virologic response with interferon-based therapy experienced decreases in inflammation and fibrosis scores vs. patients who did not undergo therapy or those who underwent therapy but did not achieve a sustained virologic response.
HCV Next Editorial Board member Mitchell L. Shiffman, MD, and colleagues followed a cohort of 348 patients with chronic HCV for 5 years to determine the effect of interferon treatment. Patients were divided into three groups: patients who deferred any treatment (n=47); patients who received interferon-based therapy (pegylated interferon with or without ribavirin) but did not reach an SVR (n=189); and patients who underwent therapy and achieved SVR (n=112).
Mitchell L. Shiffman
Patients who opted out of treatment and those who did not achieve SVR displayed increased mean inflammation scores (4.3 to 6.3 for no treatment, 5.4 to 6.7 for no SVR; P<.001) and fibrosis scores (0.9 to 1.8 for no treatment, 1.9 to 2.5 for no SVR; P<.001) during follow-up. Increases in inflammation were associated with the progression of fibrosis. Patients who achieved SVR after treatment experienced a decrease in mean inflammation score (6.7 to 2.2) and fibrosis score (3.3 to 1.8; P<.001).
“In patients with chronic HCV, a strong relationship exists between hepatic inflammation and fibrosis,” the researchers wrote. “In patients with ongoing chronic disease, increases in inflammation are associated with fibrosis progression. In contrast, achieving SVR and eradicating HCV, not just receiving interferon therapy, is associated with a marked reduction in inflammation and fibrosis regression.”
Of the patients who achieved SVR, 40% were clear of any fibrosis and 50% were clear of cirrhosis.
“The future of HCV treatment is to suppress HCV with multiple oral antiviral agents without interferon and/or ribavirin,” the researchers wrote. “The observations of the present study strongly suggest that fibrosis regression, including resolution of cirrhosis, will occur in the vast majority of patients who will achieve SVR with these future therapies.”
Disclosure: See the study for a full list of relevant financial disclosures.