Sustained virological response to hepatitis C treatment is defined as continued undetectable HCV viral load six months after completion of therapy; less is known, however, about longer-term outcomes beyond this point.

As reported in the March 2009 Hepatology, S.L. George and colleagues from St. Louis University followed 150 chronic hepatitis C patients who achieved SVR after interferon-based therapy for five years.

Participants with evidence of stage 2 or greater fibrosis on their pretreatment biopsy were offered a follow-up biopsy after four years.

Within this group, 49 received the subsequent biopsy and had their paired pretreatment and follow-up biopsies blindly rescored. After four years of follow-up, most participants showed evidence of improved liver disease: 40 (82%) had decreased fibrosis scores and 45 (92%) had decreased inflammation scores.

A subgroup of 10 patients (20%) had normal or nearly normal liver histology on the follow-up biopsy. None of the participants had conclusive evidence of HCV relapse.

However, two patients who had cirrhosis prior to treatment developed hepatocellular carcinoma (HCC) and one died, despite achieving sustained response. "In a cohort of 150 patients with SVR followed for five years, the majority of patients had good outcomes," the researchers concluded. "A minority of patients had normal or nearly normal liver tissue on long-term follow-up biopsy," they continued, but people with pretreatment cirrhosis "are at a low but real risk of HCC after SVR."

http://www.hcvadvocate.org/news/newsRev/2009/HJR-6.3.html#2

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