Long term outcome after SVR

[Bali05]

LONG-TERM CLINICAL, BIOCHEMICAL AND VIROLOGICAL OUTCOMES AFTER SUCCESSFUL HCV-THERAPY
F. Morisco1*, T. Stroffolini2, R. Granata1, L. Donnarumma1, M. Guarino1, N. Caporaso1
1Gastroenterology, University of Naples ' Federico II', Naples, 2Infectious and Tropical Disease, University La Sapienza, Rome, Italy.



Background and aims: In patients with chronic hepatitis C, therapy is considered effective when the sustained virological response (SVR) (undetectable HCV-RNA in serum 6 months after the end of therapy) is achieved. Although the persistence of HCV eradication in short or medium-term period (3-5 years) is well- established, little is known about the long-term follow-up.
The aim of the study was to evaluate the long-term persistence of HCV eradication in patients with chronic hepatitis C(CHC) who obtained SVR. In particular, we wanted to assess the risk of long-term virological relapse and liver related-complications.
Methods: From January 1989 to April 2008, 150 consecutive subjects (M/F 100/50, median age 47.69 years, range 22-67) with CHC and SVR after interferon-based therapy, were enrolled in a long-term clinical follow-up study.
137 patients had pre-treatment diagnosis of CHC and 13 patients had cirrhosis.
All patients received interferon-based therapy (66 with conventional IFN-monotherapy, 25 with conventional IFN and ribavirin, and 59 with pegylated IFN and ribavirin). The patients were followed with clinical, biochemical, virological and ultrasonographic assessments every 6 months until the 3th year of follow-up and than every 12 months. HCV-RNA assessment in serum was determined by quantitative RT-PCR ( cut-off < 50 UI/ml).

Results:
The median follow-up was 8,6 years (range:2-19.8 years). Serum HCV-RNA remained undetectable in all patients, indicating no risk of HCV recurrence independently from the schedule of therapy used. During the observation period 3 liver-related complications (2 HCC, 1 bleeding) were observed. The incidence rate of complication was 0.23%/person/year. All 3 of the events occurred in patients with pre-treatment cirrhosis. Only 1 out of 150 patients deceased for liver-related causes (HCC) with a mortality rate of 0.08%/person/year.
Conclusions: In this large cohort of CHC patients with SVR, the eradication of the virus lasted up to 20 years after treatment. Overall, patients with CHC and SVR show an excellent prognosis with no risk of viral recurrence and a very low rate of mortality, so they can be considered healed. Patients with pre-treatment evidence of cirrhosis show a rate of liver complications that cannot be neglected.

http://www1.easl.eu/easl2011/program/Posters/Abstract263.htm

[Doggie]

My last bx was 2007. Grade 0 Stage 1 (to the matter).  They offered a trial but I turned it down b.c at that time I was considering baring children.  Now, I am not but I still feel like I might want to so I am holding back.  I know I can't hold back too long b.c it is probably best to treat in this.

All I want to know is what the latest and greatest trial is and treatment - if anyone can shed light on that then please send a link and I will do my homework.

Thank you for the other link Will, I will check into that thread.

Wishing all of us a healthy liver...

[willbb]

Hi Bali..We all treat when we feel it is right for us to  give it a shot :)

My thoughts about treating with very minimal damage in todays landscape are mixed ...I guess somewhat tainted by my own first failed attempt.

I  agree.. we all must  weigh the risk of progression  and  complication of HCC with that of successful treatment. or I guess more importantly unsuccessful treatment ,especially in light of the fact of uncertainty of the resistance issue with the DAA"s.

It seems that the efficacy will improve even further in the future and hopfully Pharma gets more of a handle on  resistance  or at the very least releases what they know  to the medical community.

like you said a couple of days ago "We do what we can " ...glad you have treated and I look forward to hearing of your SVR!
Best ..

Will
  

[Bali05]

Hey Will,
When I was in Germany getting my first Fibroscan in 09 they told me I had beginning fibrosis and that it was still reversable if I treated.
That became a strong argument for me for treating sooner than later because I believe with
any amount of fibrosis the risk for HCC only goes up.
Just my personal view and what motivated me in the end.


Cheers
b

[willbb]

While I agree with Bali ..that progression of fibrosis can speed up at any time...being stage 1 or stage 0( not sure from your post which it is ..and also when was that ascertained?)  you are at worst most likely many years away from having any damage that would compromise treatment. The reason I mention this is that there are many drugs currently in trials that most would agree are going to get better and better in the future.

It is always a personal desicion when to treat based on lots of factors along with the advice of a knowledgeable doctor(in the treatment of HCV)  and entering a trial has many benefits as well as many drawbacks.
There are many trials currently recruiting ..go to clinical trials .gov.   ..also here is a link to a thread that we have going on with questions to be aware of  when thinking of a trial.

Good luck...
Will

.http://www.medhelp.org/posts/Hepatitis-C/Things-to-ask-before-participating-in-a-trial/show/1497138?personal_page_id=1008846#post_7021261

[Bali05]

Fibrosis staging was not a big consideration in my deciding to tx since I did not want to wait.
Actually my primary motivation was and is to tx asap because Hep C usually never gets any
better and I am not getting any younger. Better anti virals for my genotype 4 are still years
away. If you are looking to reverse any possible fibrosis you mght have you better get on with it  because waiting might lessen your chances. Fibrosis progression is not linear but can speed
up at any time.

What genotype are you ?

[Doggie]

What stage / grade of Hep C were you in that made you decide treatment?  I am in stage 1 grade 0 or vs.  

Did you do the newest treatment - I am looking for the some studies or clinical trials if you know of any, please pass along.  Or anyone for that matter.

[Bali05]

That sounds fabulous. Can`t wait to go back and have a multi hr massage session
at our favourite Spa..
Hope you are able to get some relaxing time.

Enjoy !

b

[Marcia2202]

Am really good! In Indo at the moment having a great time. Went to Bali, too. :-)

Congrats on finally finishing!!

[cheesenrice]

i know this is a hep c forum but are you suggesting that anyone that has either naturally acquired active or naturally acquired passive immunity to hep b actually has no immunity at all - i know the hep b vaccine offers limited protection but ive never heard of this for naturally acquired active or naturally acquired passive immunity

[Bali05]

Hi Marcia,
How are you ?
Just finished , so results will come in accordingly.

Hope all is well

b

[Marcia2202]

Yay!!!! I love this. It takes every little doubt away that might linger in the back of our minds!

Rooting for your SVR Bali. When are you getting the results?

Hugs to all!!!!

[Bali05]

FYI
HBV unlike HCV penetrates the cell nucleus where it builds a reservoir.
Because of this it can not truly be eradicated.
HCV can !

b

[cheesenrice]

hbv can be cured although its much harder to remain that way - over 90% of adults clear hbv spontaneously compared to around 20% hcv - now all we need is a hcv vaccine - hopefully

[Bali05]

What is relevant  is that HCV unlike HBV for example  can be eradicated and is CURABLE !

Cheers
b

[Bali05]

Thanks Will , we do what we can :-)

b

[cheesenrice]

im not worrying over it - all im saying is short term svr is more clinically relavant than long term - i wish you both

[willbb]

Congrats Bali on coming to the end of a long haul.  Your determination will end with SVR!

Best to you

Will

[flcyclist]

Bali said- "A healthy patient = No business!"
---------------------------------------------------------
and another suggestion:

A female mosquito looks at everyone as her next meal.  


And not picking on females, but they're the only ones that bite (or suck) or....... you know what i mean. ;D

[evangelin]

Bali said- "A healthy patient = No business!"
---------------------------------------------------------
I just ran across this quote and it seems fitting :

"To quote Mark Twain, 'To a man with a hammer, everything looks like a nail,' "

Ev

[Susan_1a_CC]

Re 2 year mark - my clinic told me they would give me a "certificate" after staying clear for 2 years that I could then use as needed, i.e getting life insurance.

[Susan_1a_CC]

Congrats on finishing tx and every wish for SVR'ing.

[evangelin]

I read your above post and started whistling the tune to, "Don't Worry,Be Happy"  Remember that tune?   That could be your post TX theme song.  :>)   Since Joe and I may have to circle the runway a few more years, we better go ahead and make it our theme too...might as well. :>)
Ev

[Bali05]

My recommendation to you is just keep worrying over 1% .
I know I am not. It is not worth 1.5 years of my life.
Chances are I would get sick because I worrry too much :-)

Cheers
b

[Bali05]

Thank you for the positive Karma.
b