Is there Improvement in liver health with treatment of hepatitis C even in the absence of SVR?

A retrospective study out of the Scripps Clinic is providing insight into whether a partial response to HCV treatment improves the overall health of the liver.

The authors analyzed records (retrospective study) of 1571 HCV positive patients who were treated with interferon or interferon plus ribavirin therapy. Of these 80% were treated with pegylated interferon monotherapy or pegylated interferon plus ribavirin combination therapy. The records were obtained from eight phase 2 to phase 4 studies. The majority of the patients were white, male, with HCV genotype 1 or 4, and viral load levels greater than 800,000 IU/mL at start of treatment. The METAVIR activity/staging model was used (stages 0 though 4; 0 equals no activity and up to 4 equal cirrhosis). Paired biopsy information (before and after treatment) was available for the 1571 patients.

The authors found that there was a “positive correlation between the degree of virologic response and improvements in METAVIR activity and fibrosis, and inverse correlation with worsening activity and fibrosis.” As the authors expected it was found that an improvement in liver health was related to a faster decrease in HCV RNA or viral load and a longer suppression of the viral load.

The authors concluded that “In patients with chronic hepatitis C who are treated with interferon-based therapies, histologic benefits may be observed even in the absence of an SVR.”

Comments: Improvement in liver health is one of the main reasons people seek treatment. Although this is a retrospective analysis it is welcome news since there may be improvement in liver health even without achieving an SVR. In addition, people who are treated many times do not have access to a liver biopsy after treatment to assess whether or not treatment improved the health of their liver. While this doesn’t conclusively prove that everyone treated has improvement in liver health it does suggest this and helps us to better understand that treatment has benefits regardless of SVR.

The HALT-C trial results did not show improvements in liver health, but many in the science and advocacy community believe that the trial design was at fault because the study medicine included only low dose pegylated interferon WITHOUT ribavirin. AF

Source:
Histologic outcomes in hepatitis C-infected patients with varying degrees of virologic response to interferon-based treatments.
Pockros PJ, Hamzeh FM, Martin P, Lentz E, Zhou X, Govindarajan S, Lok AS.
Scripps Clinic, La Jolla, CA.
Hepatology 2010