Sustained Viral Response to HCV Meds Bodes Well for Long-Term Survival

By Reuters Staff

(Reuters Health) - Patients with chronic hepatitis C virus (HCV) infection and advanced liver disease who achieve sustained viral response (SVR) have a life expectancy on par with that of the general population, according to a study released today.

Nearly three million people in the U.S. have chronic HCV infection, Dr. Adriaan J. van der Meer of Erasmus MC University Medical Center Rotterdam, the Netherlands, and colleagues note in their JAMA research letter.

These patients have a reduced life expectancy, relative to the general population, largely due to the development of cirrhosis, liver failure and cancer. Studies have shown that the risk of dying from any cause is lower in patients with chronic HCV infection and advanced hepatic fibrosis when SVR is attained, but comparisons have been limited to patients without SVR, not the general population, they explain.

The researchers assessed overall survival of a group of patients from Europe and Canada with chronic HCV infection and advanced fibrosis or cirrhosis. Follow-up started 24 weeks after antiviral therapy ended. At this point, SVR was determined and defined as no HCV RNA in a blood sample. The researchers compared overall survival in patients who did and did not have SVR with the expected survival from a matched sample from the general population.

A total of 530 HCV patients were followed for a median of 8.4 years; follow-up was complete in 454 patients (86%), and 192 (36%) attaining SVR.

Thirteen patients with SVR died, yielding a cumulative 10-year overall survival of 91.1%, which did not differ markedly from the age- and sex-matched general population (p=0.57).

One hundred patients who did not attain SVR died. In this group, the cumulative 10-year survival was 74.0% -- far lower relative to the general population (p<0.001).

"The excellent survival among patients with advanced liver disease and SVR might be explained by the associations between SVR and regression of hepatic inflammation and fibrosis, reduced hepatic venous pressure gradient, reduced occurrence of hepatocellular carcinoma and liver failure, as well as reduced occurrence of diabetes mellitus, end-stage renal disease, and cardiovascular events," the researchers say.

Limitations of their study include its retrospective design and use of general population data from the Netherlands. "However, life expectancy in the Netherlands is similar to other participating countries so this is not expected to have had a major influence on our results," the team says.

The fact that all patients received interferon-based therapy is another limitation. "Thus, these results need to be confirmed when interferon-free therapy is widely used because these highly effective regimens may be administered to patients with more comorbidity and more advanced liver disease," they say.

There is ongoing controversy about pricey new antivirals to treat HCV infection, such as sofosbuvir (Sovaldi), which cures the majority of patients but comes with a price tag of $1,000 per pill, or $84,000 for a 12-week course.

The authors did not respond to request for comment by press time.

SOURCE: https://bit.ly/1zcmM8g

JAMA 2014.

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