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  M Mazen Jamal, Kenneth J. Vega, Ehab Rabaa, David E. Johnston, Long Beach, CA; Jacksonville, FL; Rockville, MD; Everett, WA
This study discusses whether interferon can slow HCV disease progression with or without a viral response. And the effects of continued alcohol use on disease progression are discussed. Here is yet another study showing interferon slows disease progression. Aside from its antiviral effect, interferon is said slow disease progression. 226 patients with HCV cirrhosis were looked at between June 1992 and June 2000. Patients with HIV were excluded but HIV appears to accelerate HCV progression. Some patients received HCV therapy & some did not. They found that 33% developed decompensation (ascites, GI bleed, encepholopathy, jaundice). And 67% remained compensated. 65% were men, 50% white. follow-up was 52 months. 102 patients received interferon and 124 did not. The treated patients had higher platelet counts.
The study found that patients who received interferon therapy were 2.3 times less likely to experience HCV disease progression to decompensation. Patients that continued to drink alcohol heavily were 5.6 times more likely to develop decompensation. Perhaps the most important point the author stressed was that patients in the study experienced slowing of HCV disease progression whether or not they were viral responders. Not receiving interferon therapy increased risk for death by 3.8 times. So refusing to take interferon increased death in this study. Continuing heavy alcohol use increased risk for death by 11 times.
After 72 months the probability for developing decompensated cirhosis was 50% in the interferon untreated patients and 14% in the treated patients. After 72 months patients who were abstinent from alcohol had a 14% risk for decompensated disease compared to 67% for those who continued heavy alcohol use. After 72 months patients who received interferon had a 95% probaility of survival vs 68% for patients who did not receive interferon. Heavy drinkers also had decreased survival at 72 months (55%) vs those who were abstinent (98%).
There are numerous studies showing interferon can slow disease progression. But the study findings are not conclusive. The potential benefit to maintenance therapy or interferon is controversial. The data indicates that interferon slows disease progression. A large NIH study called HALT-C is looking at this question but results will not be ready for several years. A few investigators are trying to start a smalled study to get answers more quickly.
Background:The long-term prognosis of chronic liver disease secondary to hepatitis C is not clearly defined. This study examines predictive factors of decompensation and the effects of treatment and alcohol consumption on time to decompensation and death in patients with hepatitis C-related compensated cirrhosis.
Methods: A cohort of 226 patients with compensated cirrhosis was enrolled and followed up for a mean period of 52.9 months. Inclusion criteria were biopsy proven liver cirrhosis, positive hepatitis C RNA, absence of decompensation, and no evidence of hepatitis B, HIV and metabolic, or autoimmune liver diseases. Age, sex, ethnicity, age at infection, duration of infection, alcohol consumption, continuing heavy alcohol consumption, LFT's, interferon treatment, platelets, HCV RNA and genotype were evaluated as potential predictive factors for time to decompensation and death.
Results: One hundred and two patients were treated with interferon or rebetron for a mean duration of 10.2 months. During follow-up, 35 patients (15.5%) died and decompensation occurred in 74 patients (32.7%). In multivariate analysis lack of treatment and continuing heavy alcohol consumption were predictive factors of decompensation. Predictors of survival included interferon treatment and no history of heavy alcohol consumption (Table). The probability of decompensation was 0% at 2 years, 6.8% at 4 years and 14% at 6 years for treated patients and 9.2%, 18% and 50.2% for untreated patients.The probability of decompensation for patients with no heavy alcohol consumption was 0%, 4.6% and 13.8% at 2, 4 and 6 years and 15.4%, 29.8% and 67% for continuing heavy alcohol consumption patients. Death was highest among non-treated patients and patients with continuing heavy alcohol consumption.
Conclusions: 1- Continuing heavy alcohol consumption and lack of interferon therapy are independent predictors of poor outcome. 2- Survival probability is better in interferon treated patients and in patients with no heavy alcohol consumption. 3- Interferon therapy and abstinence increase the time to decompensation and death.
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