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Liver fibrosis, cirrhosis progressed faster in patients with HCV

Veterans positive for hepatitis C virus infection were more likely to be diagnosed with liver fibrosis or cirrhosis after seroconversion compared with those who were negative for the infection, according to new study data.

Adeel A. Butt, MD, MS, FACP, FIDSA, of the University of Pittsburgh School of Medicine, and colleagues, including Vincent Lo Re III, MD, MSCE, of the University of Pennsylvania Perelman School of Medicine, analyzed data of veterans from the Electronically Retrieved Cohort of HCV Infected Veterans database between 2002 and 2012. Researchers included data of patients who had a negative and subsequent positive test result for HCV antibody and positive HCV RNA test.

Adeel A. Butt

Vincent Lo Re III

“Precise rate of progression of liver disease in HCV infection is unknown because the precise time of infection with HCV is seldom known,” Butt told Healio.com/Hepatology. “Knowledge of liver disease progression is critical to determine the optimal time for treatment. We found that progression of liver disease starts early after acquiring HCV infection. This is more rapid than was previously thought.”

Overall, 1,840 patients positive for HCV were matched with 1,840 controls who were HCV-negative. Fibrosis-4 (FIB-4) index was used to measure fibrosis progression using previous laboratory data collected from the patients on an annual basis.

Among HCV-positive patients, fibrosis progression began early after diagnosis of infection compared with uninfected patients. Overall, 452 diagnoses of cirrhosis — 399 in HCV-positive patients and 113 in HCV-negative — were recorded, along with 85 hepatic decompensation events — 57 in HCV-positive patients and 28 in the HCV-negative group. Patients positive for HCV had a shorter time to developing liver cirrhosis and a faster time to the first hepatic decompensation event compared with HCV-negative patients. At 5 years, more than 15% of HCV-positive patients had cirrhosis compared with less than 5% of HCV-negative patients, according to the research.    

“About 18% of HCV-infected persons develop cirrhosis within 10 years of acquiring HCV infection, which is 3-fold higher than demographically similar HCV uninfected persons,” Butt said. “Patients with HCV should be monitored more closely and earlier after acquiring infection than we have done previously. This can potentially identify those who have the highest rate of progression…Such persons can then be prioritized for treatment.” by – Melinda Stevens

Disclosure: Butt reports receiving grants from Merck during the study and grants from Pfizer unrelated to the study. Another researcher reports receiving grants from AbbVie, Anadys, Genentech, Gilead, Merck, Novartis and Vertex, and personal fees from Bioline, Janssen, Kadmon, MedImmune, MedPace, Merck and Synteract unrelated to the study.