A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C

Jules L. Dienstag, Marc G. Ghany, Timothy R. Morgan, Adrian M. Di Bisceglie, Herbert L. Bonkovsky, Hae Young Kim, Leonard B. Seeff, Gyongyi Szabo, Elizabeth C. Wright, Richard K. Sterling, Gregory T. Everson, Karen L. Lindsay, William M. Lee, Anna S. Lok, Chihiro Morishima, Anne M. Stoddard, James E. Everhart

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Abstract

The incidence of liver disease progression among subjects with histologically advanced but compensated chronic hepatitis C is incomplete. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis Trial was a randomized study of 3.5 years of maintenance peginterferon treatment on liver disease progression among patients who had not cleared virus on peginterferon and ribavirin therapy. Patients were followed subsequently off therapy. Because maintenance peginterferon treatment did not alter liver disease progression, we analyzed treated and control patients together. Among 1,050 subjects (60% advanced fibrosis, 40% cirrhosis), we determined the rate of progression to cirrhosis over 4 years and of clinical outcomes over 8 years. Among patients with fibrosis, the incidence of cirrhosis was 9.9% per year. Six hundred seventy-nine clinical outcomes occurred among 329 subjects. Initial clinical outcomes occurred more frequently among subjects with cirrhosis (7.5% per year) than subjects with fibrosis (3.3% per year) (P < 0.0001). Child-Turcotte-Pugh (CTP) score ≥7 was the most common first outcome, followed by hepatocellular carcinoma. Following occurrence of a CTP score ≥7, the rate of subsequent events increased to 12.9% per year, including a death rate of 10% per year. Age and sex did not influence outcome rates. Baseline platelet count was a strong predictor of all clinical outcomes. During the 8 years of follow-up, death or liver transplantation occurred among 12.2% of patients with advanced fibrosis and 31.5% of those with cirrhosis. Conclusion: Among patients with advanced hepatitis C who failed peginterferon and ribavirin therapy, the rate of liver-related outcomes, including death and liver transplantation, is high, especially once the CTP score reaches at least 7.

Original languageEnglish (US)
Pages (from-to)396-405
Number of pages10
JournalHepatology
Volume54
Issue number2
DOIs
StatePublished - Aug 2011

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Chronic Hepatitis C
Fibrosis
Prospective Studies
Disease Progression
Liver Diseases
Ribavirin
Hepatitis C
Liver Transplantation
Therapeutics
Maintenance
Incidence
Platelet Count
Antiviral Agents
Hepatocellular Carcinoma
Viruses
Mortality
Liver

ASJC Scopus subject areas

  • Hepatology

Cite this

Dienstag, J. L., Ghany, M. G., Morgan, T. R., Di Bisceglie, A. M., Bonkovsky, H. L., Kim, H. Y., ... Everhart, J. E. (2011). A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. Hepatology, 54(2), 396-405. https://doi.org/10.1002/hep.24370

A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. / Dienstag, Jules L.; Ghany, Marc G.; Morgan, Timothy R.; Di Bisceglie, Adrian M.; Bonkovsky, Herbert L.; Kim, Hae Young; Seeff, Leonard B.; Szabo, Gyongyi; Wright, Elizabeth C.; Sterling, Richard K.; Everson, Gregory T.; Lindsay, Karen L.; Lee, William M.; Lok, Anna S.; Morishima, Chihiro; Stoddard, Anne M.; Everhart, James E.

In: Hepatology, Vol. 54, No. 2, 08.2011, p. 396-405.

Research output: Contribution to journalArticle

Dienstag, JL, Ghany, MG, Morgan, TR, Di Bisceglie, AM, Bonkovsky, HL, Kim, HY, Seeff, LB, Szabo, G, Wright, EC, Sterling, RK, Everson, GT, Lindsay, KL, Lee, WM, Lok, AS, Morishima, C, Stoddard, AM & Everhart, JE 2011, 'A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C', Hepatology, vol. 54, no. 2, pp. 396-405. https://doi.org/10.1002/hep.24370
Dienstag JL, Ghany MG, Morgan TR, Di Bisceglie AM, Bonkovsky HL, Kim HY et al. A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. Hepatology. 2011 Aug;54(2):396-405. https://doi.org/10.1002/hep.24370
Dienstag, Jules L. ; Ghany, Marc G. ; Morgan, Timothy R. ; Di Bisceglie, Adrian M. ; Bonkovsky, Herbert L. ; Kim, Hae Young ; Seeff, Leonard B. ; Szabo, Gyongyi ; Wright, Elizabeth C. ; Sterling, Richard K. ; Everson, Gregory T. ; Lindsay, Karen L. ; Lee, William M. ; Lok, Anna S. ; Morishima, Chihiro ; Stoddard, Anne M. ; Everhart, James E. / A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C. In: Hepatology. 2011 ; Vol. 54, No. 2. pp. 396-405.
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AU - Sterling, Richard K.

AU - Everson, Gregory T.

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AU - Lee, William M.

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