Favorable Outcomes of Chinese HCV-Related Cirrhotic Patients with Sustained Virological Response after Pegylated Interferon Plus Ribavirin Treatment

Abstract

Few studies have conducted follow-up investigations of the clinical course in HCV-related cirrhotic patients who achieved a sustained virological response (SVR) with pegylated interferon plus ribavirin treatment (PegIFN + RBV). We investigated the clinical course and laboratory data in a prospective cohort study enrolling HCV-related cirrhotic patients who received PegIFN + RBV between August 2008 and July 2013 in China. Complete blood counts, liver function tests, and HCV-RNA were serially examined. Liver-related complications were recorded. To detect hepatocellular carcinoma (HCC), alpha-fetoprotein assays, and ultrasound scans were repeated at 6-month intervals. Twenty-five patients were enrolled, including 8 patients with decompensation events before treatment. Eighteen patients achieved SVR with a mean follow-up period of 25.78 months. During the follow-up period, only one patient exhibited HCV-RNA positivity and no decompensation events were detected, but 4 patients developed HCC after SVR. APRI decreased more in patients with SVR than in patients with non-SVR (median, -1.33 versus 0.86, P < 0.001). The albumin levels and platelet counts significantly increased during the follow-up period after SVR (44.27 ± 4.09 versus 42.63 ± 4.37, P = 0.037 and 173.89 ± 87.36 versus 160.11 ± 77.97, P = 0.047). These data indicated that HCV-related cirrhotic patients with SVR after PegIFN + RBV may have a favorable clinical course and improvements in laboratory data. Moreover, HCC should be monitored.

Figure 1

Changes in ALT values, absolute platelet counts, albumin values, and APRI levels in each group based on different treatment outcomes. The ALT levels (a) and APRI values (d) significantly reduced in the SVR patients compared with the non-SVR patients. Platelet counts (b) and albumin levels (c) increased in the patients with SVR and decreased in the non-SVR patients. P values represent comparisons between values at the initiation of treatment and at the last visit using the Wilcoxon signed-rank test or Student's t-test. ALT: alanine aminotransferase; PLT: platelet counts; ALB: albumin; APRI: aspartate aminotransferase to platelet ratio index; SVR: sustained virological response. ^∗P < 0.05; ^∗∗P < 0.01; ^∗∗∗P < 0.001.

Figure 2

Serial changes in ALT values, absolute platelet counts, albumin values, and APRI levels in patients with SVR. ALT levels decreased progressively after the initiation of treatment until the end of the follow-up period (a). Platelet counts markedly decreased at treatment week 4 and then gradually increased (b). Albumin levels markedly increased during the follow-up period after the certification of SVR (c). APRI values decreased progressively during the therapy and tended to decline continuously throughout the follow-up (d). ALT: alanine aminotransferase; PLT: platelet; ALB: albumin; APRI: aspartate aminotransferase to platelet ratio index; BL: baseline; 4 W: treatment week 4; 12 W: treatment week 12; 24 W: treatment week 24; EOT: end of treatment response; SVR: sustained virological response; EOF: end of follow-up. ^∗P < 0.05; ^∗∗P < 0.01; ^∗∗∗P < 0.001.