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Reaching SVR after antiviral therapy improves advanced fibrosis survival

Patients with advanced liver disease due to chronic hepatitis C virus had improved survival when achieving a sustained virologic response after undergoing antiviral therapy vs. patients who did not achieve a sustained virologic response, according to study data.

“The clinical benefit of antiviral therapy in patients with mild liver disease is less clear,” the researchers wrote. “Therefore, we aimed to study the all-cause and liver-related mortality, incidence of [hepatocellular carcinoma] and liver failure or liver transplantation in SVR and nonsustained virological responders to antiviral therapy with different stages of fibrosis and a follow-up period of 21 years.”

A total of 714 patients (mean age, 51.4 ± 12 years) who underwent antiviral therapy for chronic HCV between 1990 and 2012 were reviewed and followed for 21 years. Of those patients, 276 were female, 458 had HCV genotype 1 and 210 of 540 patients who had a liver biopsy before therapy had stage 3 or 4 fibrosis.

Overall, 77% of patients (n = 551) were sustained responders to their antiviral treatment and 23% did not achieve SVR (n = 163). Ninety-nine percent of patients who reached SVR (n = 546) had undetectable HCV RNA at the end of follow-up.

During follow-up, 48 patients died; 15 had reached an SVR and 33 did not (P < .001). The patients who did not achieve an SVR had increased 5-year mortality compared with patients who achieved SVR (8.6% vs. 1.8%), as well as increased 10-year mortality rate (19.1% vs. 2.7%).  Twenty-nine patients developed decompensated liver disease. Of these patients, nine reached SVR and 20 had not (P < .001). Nineteen patients developed HCC, of which 10 reached SVR and 19 did not (P < .001).

Not achieving SVR was found to be an independent predictor for developing HCC (HR = 2.36; 95% CI, 1.07-5.23); liver-related complications (HR = 2.62; 95% CI, 1.18-5.81); and mortality (HR = 3.46; 95% CI, 1.91-6.29).

“Our study reconfirms that successful viral eradication is durable,” the researchers concluded. “Furthermore, achieving a sustained virological response improves survival in patients with advanced liver disease due to HCV infection. The risk of development of HCC or liver failure is decreased, but not completely prevented. Thus, patients should have further follow-up after achieving a SVR.”

Disclosure: Rutter reports serving as a speaker for MSD Austria and Madaus. Please see the full study for a list of all other researchers’ relevant financial disclosures.