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. 2015 Feb;175(2):178-85.
doi: 10.1001/jamainternmed.2014.6502.

Liver fibrosis progression in hepatitis C virus infection after seroconversion

Adeel A Butt  1 , Peng Yan  2 , Vincent Lo Re 3rd  3 , David Rimland  4 , Matthew B Goetz  5 , David Leaf  5 , Matthew S Freiberg  1 , Marina B Klein  6 , Amy C Justice  7 , Kenneth E Sherman  8 ; ERCHIVES (Electronically Retrieved Cohort of HCV Infected Veterans) Study Team
Affiliations

Liver fibrosis progression in hepatitis C virus infection after seroconversion

Adeel A Butt et al. JAMA Intern Med. 2015 Feb.

Abstract

Importance: Knowing the rate of liver fibrosis progression in hepatitis C virus (HCV)-infected persons can help inform patients and providers (clinicians, medical institutions or organizations, and third-party payers) in making treatment decisions.

Objective: To determine the rate and factors associated with liver fibrosis progression and hepatic decompensation in persons after acquiring HCV infection.

Design, setting, and participants: Secondary data analysis of persons in the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a national Veterans Affairs (VA) database, between 2002 and 2012. Among 610 514 persons in ERCHIVES (half were HCV positive), we identified those with an initial negative and subsequent positive test result for HCV antibody and positive HCV RNA test result (HCV+). Controls had 2 negative HCV antibody test results (HCV-) in a comparable time frame and were matched 1:1 on age (in 5-year blocks), race, and sex. We excluded persons with human immunodeficiency virus, hepatitis B, less than 24 months of follow-up, hepatocellular carcinoma, and cirrhosis at baseline.

Main outcomes and measures: Progression of liver fibrosis as estimated by the Fibrosis-4 (FIB-4) index; development of cirrhosis, defined by a FIB-4 score greater than 3.5; and development of hepatic decompensation.

Results: The evaluable data set consisted of 1840 persons who were HCV+ and 1840 HCV- controls. The HCV+ persons were younger and had a lower mean (SD) body mass index (27.39 [5.51] vs 29.49 [6.16]; P < .001), a higher prevalence of alcohol and drug abuse and dependence diagnoses, and higher serum aminotransferase levels, but had a lower prevalence of diabetes and hypertension. Fibrosis progression started early after infection among HCV+ persons and tapered off after 5 years. A total of 452 cirrhosis and 85 hepatic decompensation events were recorded. After 10 years of follow-up, HCV+ persons were more likely to have a diagnosis of cirrhosis compared with HCV- controls (18.4% vs 6.1%). Nine years after diagnosis of cirrhosis, hepatic decompensation events were uncommon but had a higher rate in the HCV+ group (1.79% vs 0.33%).

Conclusions and relevance: Persons who seroconverted for HCV have a more rapid progression of liver fibrosis and accelerated time to development of cirrhosis after seroconversion compared with HCV- controls. Fibrosis progression occurs early after infection; however, hepatic decompensation is uncommon after diagnosis of cirrhosis.

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Conflict of interest statement

Disclosures: Dr Butt reports receiving grants from Merck during the conduct of the study and grants from Pfizer outside the submitted work. Dr Sherman reports receiving grants from AbbVie, Anadys, Genentech, Gilead, Merck, Novartis, Vertex, and personal fees from Bioline, MedImmune, Merck, Kadmon, Janssen, MedPace, and Synteract, all outside the submitted work. No other disclosures are reported.

Figures

Figure 1
Figure 1. Flowchart of the Patients Included in the Study
Ab indicates antibody; FIB-4, Fibrosis-4; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HIV, human immunodeficiency virus; −, negative; and +, positive.
Figure 2
Figure 2. Progression of Liver Fibrosis Over Time and Kaplan-Meier Curves of Time to Development of Cirrhosis and First Hepatic Decompensation
A, Using the Fibrosis-4 (FIB-4) index as a measure of liver fibrosis. B, Using the FIB-4 index, adjusted for baseline FIB-4 score (P < .001). C, P < .001.
See this image and copyright information in PMC

Comment in

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