Abstract
BackgroundThe long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy. This study aimed to assess the impact of antiviral treatment on the development of HCC and mortality in patients with chronic HCV infection.MethodsA systematic review was conducted for studies that evaluated the antiviral efficacy for patients with chronic hepatitis C or assessed the development of HCC or mortality between SVR (sustained virologic response) and non-SVR patients. The methodological quality of the enrolled publications was evaluated using Risk of Bias table or Newcastle-Ottawa scale. Random-effect model meta-analyses and meta-regression were performed. Publication bias was assessed.ResultsIn total, 59 studies (4 RCTs, 15 prospective and 40 retrospective cohort studies) were included. Antiviral treatment was associated with reduced development of HCC (vs. no treatment; OR 0.392, 95% CI 0.275–0.557), and this effect was intensified when SVR was achieved (vs. no SVR, OR: 0.203, 95% CI 0.164–0.251). Antiviral treatment was associated with lower all-cause mortality (vs. no treatment; OR 0.380, 95% CI 0.295–0.489) and liver-specific mortality (OR 0.363, 95% CI 0.260–0.508). This rate was also intensified when SVR was achieved [all-cause mortality (vs. no SVR, OR 0.255, 95% CI 0.199–0.326), liver-specific mortality (OR 0.126, 95% CI 0.094–0.169)]. Sensitivity analyses revealed robust results, and a small study effect was minimal.ConclusionsIn patients with chronic hepatitis C, antiviral therapy can reduce the development of HCC and mortality, especially when SVR is achieved.
Highlights
The long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy
SVR24 or SVR12, which is the state of undetectable HCV RNA in a sensitive assay with a lower limit of detection
The majority of studies assessed short-term prognosis and the long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of HCV-related morbidity and mortality, including disease progression to advanced hepatic fibrosis or cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), and liver-specific death, especially according to the response to antiviral therapy
Summary
The long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of hepatitis C virus (HCV)-related morbidity and mortality according to the response to antiviral therapy. This study aimed to assess the impact of antiviral treatment on the development of HCC and mortality in patients with chronic HCV infection. Antiviral treatment for chronic hepatitis C (CHC) aims to prevent hepatitis C virus (HCV)-related morbidity and mortality, including complications of liver fibrosis or cirrhosis and the development of hepatocellular carcinoma (HCC). The majority of studies assessed short-term prognosis and the long-term clinical outcomes of antiviral therapy for patients with chronic hepatitis C are uncertain in terms of HCV-related morbidity and mortality, including disease progression to advanced hepatic fibrosis or cirrhosis, hepatic decompensation, HCC, and liver-specific death, especially according to the response to antiviral therapy. Viral replication of HCV is not known to be directly related to HCC development [4]
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