Fibrosis in HCV genotype 3 progresses with age
Evidence of fibrosis was common in older patients with hepatitis C virus genotype 3 infection, indicating fibrosis progresses with age and this patient population should be treated as often and with the same medications as other severe HCV patient populations, according to data presented at the British Society of Gastroenterology Annual Meeting.
According to Keeley Fairbrass, of the Digestive Disease Centre, Bradford Teaching Hospitals NHS Foundation Trust, U.K., and colleagues, The National Institute for Health and Care Excellence (NICE) previously issued a guidance that recommended only patients with moderate to severe HCV be treated. More recently, NICE advised that patients with HCV genotype 3 be treated with pegylated interferon plus ribavirin, and not direct-acting antivirals.
The researchers sought to determine the rate of fibrosis in this patient population, due to the fact the current recommended treatment indicates a longer treatment duration with lower sustained virologic response and more adverse events.
They analyzed data from a single center database to measure demographics, age of liver biopsy, fibrosis stage and SVR in patients with HCV genotype 3. Between 1998 and 2015, 477 patients underwent biopsy.
“We aimed to plot the rate of progression of fibrosis in HCV [genotype 3] patients to ensure NICE guidance isn’t disadvantageous to this group,” the researchers wrote.
Among those with HCV genotype 1 (n = 112; 81 men, average age 40 years; 31 women, average age 42 years), 48% achieved SVR. In the HCV genotype 2 group (n = 16; 10 men, average age 39 years; 6 women, average age 43 years), 75% achieved SVR. For HCV genotype 3 (n = 337; 194 men, average age 39 years; 143 women, average age 40 years), 68% achieved SVR. In the HCV genotype 4 group (n = 12; 10 men, average age 38 years; 2 women, average age 45 years), 42% achieved SVR.
In patients with F0 to F2 fibrosis, SVR was 80%; in patients with F3 to F4 fibrosis, SVR was 70%; and in patients with F5 to F6, SVR was 65%.
“The point prevalence of fibrosis in HCV [genotype 3] at the time of liver biopsy … [c]onfirms that fibrosis progresses with age, but not in an exponential way and also recognizes the well-described fall in SVR with increasing fibrosis,” the researchers wrote.
The researchers concluded: “Our SVR data strongly suggests that we should provide all of our HCV [genotype 3] patients with the new potent DAAs to prevent progression of disease and subsequent consequences. We urge for a change in the current guidance.” – by Melinda Stevens
Fairbrass K, et al. Abstract #PTH-100. Presented at: British Society of Gastroenterology Annual Meeting; June 20-23, 2016; Liverpool, U.K.
Disclosure: The researchers report no relevant financial disclosures.