Does the health of the liver improve after someone achieves a sustained virological response? That’s what researchers Sarah L. George and colleagues set out to answer with a long-term study of patients who achieved an SVR.

A total of 150 patients who had achieved a sustained virological response (SVR = HCV RNA (viral load) undetectable 24 weeks post-treatment) and who were originally biopsied and scored with fibrosis stage 2 or higher (Ishak system – with 0 being no fibrosis and 6 being cirrhosis) were enrolled in the study between June 1997 and April 2002.  The average age at time of study enrollment was 49 years old; 49% were female, 98% were Caucasian and the genotype distribution was similar to the genotype distribution generally seen in the United States.  Almost all of the patients (87%) were treated with standard interferon (3 shots a week) plus ribavirin daily.  Ninety-eight patients (65%) were treated for one year and the other 35% were treated for 6 months.  Out of the original 150 patients enrolled, 128 patients (85%) were followed through their fourth year and 108 patients (72%) were followed for five or more years after achieving an SVR.

Pretreatment and long-term follow-up biopsies were performed in 49 patients and blindly scored – that is the person evaluating the biopsy did not have patient information or knowledge of the previous biopsy score.

Of the patients biopsied, 40 patients (82%) had a decrease in fibrosis score, and 45 (92%) had a decrease in the combined inflammation score.  Ten patients (20%) who had follow-up biopsy had near or nearly normal livers.

Two patients with pre-treatment cirrhosis developed hepatocellular carcinoma (HCC-liver cancer) and one patient died.  However, all of the other patients with pre-treatment cirrhosis or advanced fibrosis had improved fibrosis scores on their long-term follow-up biopsy.

This was the longest and largest study of its kind and the results are very encouraging.  But, the bad news is that one of those patients with pre-treatment cirrhosis died even after achieving an SVR.  These results confirm previous findings that have had similar outcomes.  The two important messages from this study are:

• The vast majority of people who achieve an SVR have improved inflammation and fibrosis scores.  But larger and longer studies are needed to confirm these findings.
• People with pre-treatment cirrhosis should be closely monitored even when an SVR is achieved because there is a risk that a small minority of patients will continue to have severe disease progression leading to death.

Reference
George, S. et al. Clinical, virologic, histologic, and biochemical outcomes after successful HCV therapy: A 5-year follow-up of 150 patients. Hepatology. Volume 49 Issue 3

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