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High-grade liver inflammation may predict treatment response in patients with HCV

Patients with chronic hepatitis C who experienced a higher degree of liver inflammation were more responsive to treatment with interferon alpha and ribavirin in a recent study.

The retrospective cohort study in Pakistan included data from 876 patients with chronic HCV who had completed a 24-week treatment regimen with interferon alpha and ribavirin. End of treatment response (ETR) was determined, and the degree of liver inflammation according to pretreatment biopsy was assessed as a response predictor.

Among 672 evaluable patients, 569 had low- and 103 had high-grade inflammation. The mean age of the study participants was 36.9 years, and patients with high-grade inflammation were significantly older than low-grade patients (P=.03). Pretreatment levels of mean serum alanine aminotransferase (ALT) were significantly higher among high-grade patients compared with low-grade (119.2 ± 76.6 U/L vs. 85.6 ± 66.6 U/L; P<.01), as were Hb levels (15.0 ± 4.1 g/dL vs. 13.6 ± 1.9 g/dL; P=.025). Mean albumin levels before treatment were significantly lower among patients with high-grade inflammation (3.0 ± 0.4 g/dL vs. 4.1 ± 0.4 g/dL; P=.04).

After adjusting for age, total leukocyte count and pretreatment ALT levels, investigators found through multivariable analysis that ETR was associated with high-grade liver inflammation (RR=1.17 compared with low-grade inflammation; 95% CI, 1.12-1.18). The association remained significant for patients with bridging fibrosis and cirrhosis (RR=1.09; 95% CI, 1.02-1.19), but not for those without fibrosis (RR=0.97; 95% CI, 0.68-1.07) or portal fibrosis (RR=1.02; 95% CI, 0.95-1.03).

AUROC analysis indicated that ALT levels were moderately accurate for severe liver inflammation compared with minimal inflammation (AUROC=0.871 in men; 0.744 in women), but less accurate in measuring mild inflammation vs. minimal inflammation (AUROC=0.629 for men; 0.638 for women) and moderate inflammation compared with minimal inflammation (AUROC=0.696 for men; 0.688 for women).

“This study shows that treating physicians should start treatment of [chronic HCV] patients at an early age for favorable response,” the researchers wrote. “Patients having higher grades of liver inflammation … will [respond] more to interferon alpha and ribavirin therapy. Though liver biopsy is not done routinely, higher levels of serum ALT can point toward severe inflammation. Other liver function tests like low levels of serum albumin also reflect high grades of liver inflammation.”