Association of sustained virologic response with reduced progression to liver cirrhosis in elderly patients with chronic hepatitis C

Abstract

Objective

We studied the effect of sustained virologic response (SVR) after treatment with pegylated-interferon (PEG-IFN) plus ribavirin on the development of liver cirrhosis in elderly patients with chronic hepatitis C (CHC).

Patients and methods

This retrospective study enrolled 145 elderly CHC patients (aged ≥65 years) who were treatment-naïve and were treated with PEG-IFN plus ribavirin for 6 months between January 2005 and December 2011. Abdominal sonography was performed and liver biochemistry was studied at baseline, at the end of treatment, and every 3–6 months thereafter. The development of liver cirrhosis and related complications was evaluated at the follow-ups. The aspartate aminotransferase-to-platelet ratio index was used as a noninvasive maker for fibrosis.

Results

The mean patient age was 69.1±3.3 years, and the average follow-up time was 5.5 years (standard deviation: 2.5 years, range: 1.1–12.3 years). Ninety-five patients (65.5%) achieved SVR, and 26 (17.9%) discontinued treatment. Twenty-seven patients (18.6%) developed liver cirrhosis after treatment. Patients without SVR had significantly greater risk of liver cirrhosis than those with SVR (hazard ratio [HR]: 3.39, 95% confidence interval [CI]: 1.312–8.761, P=0.012). The difference in 3-year cumulative incidence of liver cirrhosis was 24.8% greater for patients without SVR (35.2%, 95% CI: 13.0–57.5, P=0.012) compared with those with SVR (10.4%, 95% CI: 3.1–17.7). There was a trend of a higher baseline aspartate aminotransferase-to-platelet ratio index score in patients who progressed to liver cirrhosis compared with those who did not progress (2.1±1.2 vs 1.6±1.3, P=0.055), but the difference failed to reach significance by Cox regression (adjusted HR: 1.285, 95% CI: 0.921–1.791, P=0.14).

Conclusion

An SVR following PEG-IFN combination treatment can reduce the risk of liver cirrhosis in elderly CHC patients.

Keywords:

• hepatitis C
• sustained virologic response
• pegylated interferon
• ribavirin
• liver cirrhosis

Acknowledgments

The authors would like to thank their nursing departments for their assistance in procuring record. This study was funded by Dalin Tzu Chi General Hospital (DTCRD99(2)-E-13).

Author contributions

Chih-Wei Tseng contributed to statistical analysis and drafting of the manuscript, and provided material support. Ting-Tsung Chang and Shu-Fen Wu were involved in critical revision of the manuscript for important intellectual content. Shinn-Jia Tzeng performed statistical analysis. Yu-Hsi Hsieh, Tsung-Hsing Hung, and Hsiang-Ting Huang provided material support. Kuo-Chih Tseng provided material support and was involved in critical revision of the manuscript for important intellectual content. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.