P.1.18: LONG-TERM HCV-ERADICATION. A 20 YEARS CLINICAL, VIROLOGICAL AND BIOCHEMICAL PROSPECTIVE STUDY

Abstract

Background and aim: In patients with chronic hepatitis C, therapy is considered effective when the sustained virological response (SVR) is achieved. SVR is defined as HCV-RNA negativity in serum 6 months after the end of therapy. Although the persistence of HCV eradication in short or medium-term period (3-5 years) is wellestablished, data about the long-term follow-up are still uncertain. The aim of the study was to evaluate the long-term persistence of HCV eradication in patients with chronic hepatitis C (CHC) who obtained SVR. In particular, we wanted to assess the risk of long-term virological relapse and liver related-complications. Material and methods: From January 1989 to Aprill 2008, 150 consecutive subjects (M/F 100/50, median age 47.69 years, range 22-67) with CHC and SVR after interferon-based therapy, were enrolled in a long-term follow-up study. 137 patients had pre-treatment diagnosis of CHC and 13 patients had cirrhosis. All of the patients received interferon-based therapy, with or without Ribavirin (66 with conventional IFN-monotherapy, 25 with conventional IFN and ribavirin, and 59 with pegylated IFN and ribavirin).The patients were followed with clinical, biochemical, virological and ultrasonographic assessments every 6 months until the 3th year of follow-up and than every 12 months. HCV-RNA assessment in serum was determined by quantitative RT-PCR. Results: The median follow-up was 8.6 years (range: 2-19.8 years). Serum HCV-RNA remained undetectable in all patients, indicating no risk of HCV recurrence, independently from the schedule of therapy used.During the observation period 3 liver-related complications (2 HCC, 1 variceal bleeding) were observed. The incidence rate of complications was 0.23%/person/year. All 3 of the events occurred in patients with pre-treatment cirrhosis. Only 1 out of 150 patients deceased for liver-related causes (HCC) with a mortality rate of 0.077%/person/year Conclusions: In this cohort of CHC patients with SVR, the eradication of the virus lasted up to 20 years after treatment. Thus, patients with CHC and SVR show an excellent prognosis with no risk of viral recurrence and a very low rate of mortality, meaning that they can be considered healed. Patients with pre-treatment evidence of cirrhosis show a rate of liver complications that cannot be neglected.