The aim of the study was to compare HCV disease
progression in the people who naturally cleared the virus (non-chronic
group) or those who achieved an SVR or viral cure to those who resolved
acute infection or who were treated, but did not achieve an SVR.
The end-point of the study was
to compare the disease progression (cirrhosis) between the groups. The
authors found that overall 9.3% developed cirrhosis (largely in the
In the chronic /non-SVR groups,
15.3% of the participants showed clinical signs of end-stage liver
disease compared to only 6% in the non-chronic/SVR group. The
information that wasn’t given in the abstract is if treatment without an
SVR provided any benefit.
This is an interesting study
because the women who were infected because of HCV-infected anti-D
injections were immediately identified as having liver disease and were
given medical care and counseling on lifestyle changes such as
abstaining from alcohol.
Certainly the slower disease
progression can be attributed to the medical care and monitoring, but
another reason for the slower disease progression is that women, in
general, have a slower disease progression than men.
The study confirms that
naturally clearing the virus and achieving a viral cure reduces the
rate of HCV disease progression. But as stated above medical care
and monitoring from the time of initial infection can also slow HCV
disease progression. -AF
2013 Aug 8. doi: 10.1002/hep.26644. [Epub ahead of print]
Evaluation of liver disease progression in the German HCV (1b)-contaminated anti-D cohort at 35 years after infection.
Wiese M, Fischer J, Löbermann M, Göbel U, Grüngreiff K, Güthoff W, Kullig U, Richter F, Schiefke I, Tenckhoff H, Zipprich A, Berg T, Müller T; for the EAST GERMAN HCV STUDY GROUP.
Hepatologische Schwerpunktpraxis, Nordstr. 17 – 21, Leipzig, Germany.
The natural course of HCV infection remains
controversial. The German HCV (1b)-contaminated anti-D cohort provides
an ideal population to investigate the natural course of HCV infection
in a large and homogenous cohort of young women from the date of HCV
inoculation. Our previous follow-up studies at 20 years and 25 years
after infection suggested slow fibrosis progression rates in this
The aim of our prospective community-based
multicenter study was to re-evaluate the liver disease progression in
718 patients of the original anti-D cohort at 35 years after infection.
Patients with self-limited HCV infection (n=189)
were compared to those who failed to eliminate the virus spontaneously
(n=529), comprising patients who were treatment naive (n=197) or
achieved a sustained virological response (SVR, n=149) respectively
failed to clear the virus (non-SVR, n=183) after antiviral therapy.
In the overall cohort, 9.3% of patients showed
clinical signs of liver cirrhosis at 35 years after infection. Liver
disease progression largely depended on the HCV infection status. The
highest proportion of patients with clinical signs of end-stage liver
disease was observed in the non-SVR group (15.3%), whereas decreased
cirrhosis rates were detected in the SVR group (6%) and in patients
with self-limited HCV infection (1.1%, p=6.2×10-6 ). Overall survival
was significantly enhanced following SVR compared to treatment naive
patients or non-SVR (p=0.027).
The present study provides further evidence for a
mild but significant disease progression at 35 years after infection in
the German HCV (1b)-contaminated anti-D cohort. Patients with
self-limited HCV infection or SVR after antiviral treatment were
protected from progressive liver disease and showed the best clinical
long-term outcome. (Hepatology 2013; 00:000-000).
© 2013 by the American Association for the Study of Liver Diseases.
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