Brief Article
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World J Gastroenterol. May 14, 2013; 19(18): 2793-2798
Published online May 14, 2013. doi: 10.3748/wjg.v19.i18.2793
Sustained virological response: A milestone in the treatment of chronic hepatitis C
Filomena Morisco, Rocco Granata, Tommaso Stroffolini, Maria Guarino, Laura Donnarumma, Laura Gaeta, Ilaria Loperto, Ivan Gentile, Francesco Auriemma, Nicola Caporaso
Filomena Morisco, Rocco Granata, Maria Guarino, Laura Donnarumma, Laura Gaeta, Ilaria Loperto, Francesco Auriemma, Nicola Caporaso, Dipartimento di Medicina Clinica e Chirurgia, Gastroenterology Unit, University of Naples “Federico II”, 80131 Naples, Italy
Tommaso Stroffolini, Dipartimento di Malattie Infettive e Tropicali, University of Rome “La Sapienza”, 00161 Rome, Italy
Ivan Gentile, Dipartimento di Medicina Clinica e Chirurgia, Infectious Diseases Unit, University of Naples “Federico II”, 80131 Naples, Italy
Author contributions: Morisco F and Caporaso N designed the study; Granata R, Donnarumma L, Guarino M, Loperto I, Auriemma F, Gentile I and Gaeta L performed the majority of the experiments; Morisco F, Caporaso N, Granata R and Stroffolini T analyzed and expanded the data; Morisco F, Granata R and Caporaso N wrote the manuscript.
Correspondence to: Filomena Morisco, MD, Chair of Gastroenterology, Dipartimento di Medicina Clinica e Chirurgia, Gastroenterology Unit, University of Naples “Federico II”, Via S Pansini, 5, 80131 Naples, Italy.
Telephone: +39-81-7464746 Fax: +39-81-7464746
Received: August 31, 2012
Revised: March 8, 2013
Accepted: March 15, 2013
Published online: May 14, 2013

AIM: To evaluate the long-term eradication of hepatitis C virus (HCV) infection and liver-related complications in chronically infected patients that have achieved sustained virological response.

METHODS: One hundred and fifty subjects with chronic hepatitis C (CHC) or cirrhosis and sustained virological response (SVR) between the years of 1989 and 2008 were enrolled in a long-term clinical follow-up study at the Gastrointestinal and Liver Unit of the University Hospital of Naples “Federico II”. At the beginning of the study, the diagnosis of HCV infection was made on the basis of serum positivity for antibodies to HCV and detection of HCV RNA transcripts, while a diagnosis of chronic hepatitis was formulated using imaging techniques and/or a liver biopsy. SVR was achieved by interferon-based therapy, both conventional and pegylated, with and without ribavirin treatment. The patients were evaluated for follow-up at a median length of 8.6 years, but ranged from 2-19.9 years. Among them, 137 patients had pre-treatment CHC and 13 had cirrhosis. The patients were followed with clinical, biochemical, virological, and ultrasound assessments on a given schedule. Finally, a group of 27 patients underwent a liver biopsy at the beginning of the study and transient elastography at their final visit to evaluate changes in liver fibrosis.

RESULTS: The median follow-up was 8.6 years (range 2-19.9 years). HCV RNA remained undetectable in all patients, even in patients who eventually developed liver-related complications, indicating no risk of HCV recurrence. Three liver-related complications were observed: two cases of hepatocellular carcinoma and one case of bleeding from esophageal varices resulting in an incidence rate of 0.23%/person per year. Further, all three complications took place in patients diagnosed with cirrhosis before treatment began. Only one death due to liver-related causes occurred, resulting in a mortality rate of 0.077% person per year. This amounts to a 99.33% survival rate in our cohort of patients after therapy for HCV infection. Finally, of the 27 patients who underwent a liver biopsy at the beginning of the study, a reduction in liver fibrosis was observed in 70.3% of the cases; only three cases registering values of liver stiffness indicative of significant fibrosis.

CONCLUSION: Patients with CHC and SVR show an excellent prognosis with no risk of recurrence and a very low rate of mortality. Our data indicate that virus-eradication following interferon treatment can last up to 20 years.

Keywords: Antiviral therapy, Cirrhosis, Hepatitis C virus, Sustained virological response, Fibrosis

Core tip: This study represents one of the longest follow-up studies on the natural history of successfully treated chronically hepatitis C virus (HCV) infected individuals. The outcome of the study was very positive, as it revealed an extremely high survival rate, an extremely low rate of liver complications, and a significant reduction in liver fibrosis in patients who have achieved sustained virological response (SVR). All of the patients without cirrhosis before starting the treatment showed no signs of evolution or decompensation over the years of observation, proving that SVR positively changes the natural history in individuals with HCV-infection.