LONG TERM FOLLOW-UP OF HCV COMPENSATED CIRRHOSIS

L SerfatyØ{1}, H AumaitreØ{1}, O ChazouilleresØ{1}, L orand-JoubertØ{2}, JC PetitØ{2}, R PouponØ{1}. Ø{1}Unite d'Hepatologie, Ø{2}Service de Bacteriologie-Virologie, Hopital St-Antoine, Paris, France.

The aim of this study was to assess the incidence of decompensation (ascitis, jaundice, GI bleeding, encephalopathy), hepatocellular carcinoma (HCC) and survival in patients with HCV compensated cirrhosis , taking into account for genotype and IFN therapy.

Methods:
Between 1989 and 1994, 668 consecutive asymptomatic patients underwent liver biopsy in our liver unit because of positivity for anti-HCV antibodies and elevated ALT activity. Among them, 103 had liver cirrhosis. The median follow-up was 40 mo. 59 patients were treated with IFN for a mean duration of 11±6 mo, 3 (5%) had prolonged biochemical and virological response.

Results:
HCV genotypes (Inno-LiPa) (n=95) were predominantly 1b (52%) and 3a (23%). During follow-up, 25 patients (24%) presented complications of cirrhosis: HCC in 10 (10%) and decompensation in 15 tumor free patients. Cumulative probability of overall complications was 18 and 27% at 2 and 4 years respectively. Death occurs in 15 patients (15%). Causes of death were liver failure in 5, HCC in 8, GI bleeding in 1 and unrelated cause in 1. Three patients were transplanted for liver failure. Cumulative probability of survival was 96 and 84% at 2 and 4 years respectively. Cox's regression analysis identified 3 independent predictive factors: bilirubin and albumin levels at entry, and absence of IFN therapy. IFN treated patients and untreated patients were not significantly different in terms of epidemiological characteristics, HCV genotype and liver function. Cumulative probability of survival at 4 years was significantly different between treated and untreated patients (94% vs 60%, p<0.0001).

Conclusion:
In patients with HCV compensated cirrhosis:
1) complications of cirrhosis occur in a high proportion of patients, whatever the genotype involved.
2) The degree of severity of cirrhosis and absence of IFN therapy were the two independent predictive factors of bad prognosis.

Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting