Influence of sustained viral response on the regression of fibrosis and portal hypertension in cirrhotic HCV patients treated with antiviral triple therapy

Abstract

Background and aims:The regression of liver fibrosis and portal hypertension (PH) and their influence on the natural history of compensated hepatitis C virus (HCV)-related cirrhosis has not been studied previously. Our objective was to evaluate the influence of sustained virologic response (SVR) on the portal pressure gradient (HVPG) and non-invasive parameters of PH and prognostic factors of response.Methods: Sixteen patients with compensated HCV genotype 1-related cirrhosis with PH (HVPG > 6 mmHg) without beta-blocker therapy were considered as candidates for PEGα2a + RBV + BOC (48 weeks; lead-in and accepted stopping rules). A hemodynamic study and Fibroscan ® were performed at baseline, at eight weeks and, in the case of SVR, 24 weeks after treatment. In each hemodynamic study, serum samples were analyzed for inflammatory biomarkers associated with PH.Results: In eight cases, SVR was obtained; five patients relapsed, and treatment was stopped early for non-response to lead in (one case) and a decrease of < 3 log at week 8 (two patients).

Value and innovation of direct-acting antivirals: long-term health outcomes of the strategic plan for the management of hepatitis C in Spain

“…SVR patients with stage F2 fibrosis were considered as no longer at risk of disease progression, whereas those with stage F3 or F4 fibrosis remained at risk of developing DC or HCC. In addition, according to the published data, the achievement of an SVR following treatment in some cirrhotic patients could lead to the fibrosis regression (23). Therefore, this transition was considered in the simulation of disease for patients in the SVR F4 state.…”

Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

“…Hemodynamic studies were performed as previously described[ 15 ]. Briefly, after an overnight fast a catheter introducer was placed under local anesthesia in the right internal jugular vein using the Seldinger technique and was used to advance a 7-F balloon-tipped catheter into the right hepatic vein and a Swan-Ganz catheter into the pulmonary artery under fluoroscopic guidance.…”

Surveillance for portal hypertension in the course of liver cirrhosis

“…The successful treatment of the underlying disease improves the architecture and function of the liver, leading to a reduction in portal hypertension and preventing variceal bleeding – a complication of liver cirrhosis [ 10 - 12 ]. The measurement of HVPG is an acceptable predictor of clinical outcome in patients with non-cholestatic cirrhosis, with a change in HVPG of 10% or more being considered significant.…”