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J Gastroenterol Hepatol. 2017 Mar;32(3):548-557. doi: 10.1111/jgh.13500.

Characterization of fibrosis changes in chronic hepatitis C patients after virological cure: A systematic review with meta-analysis.

Liu Z1,2, Wei X1,2, Chen T1,2, Huang C1,2, Liu H2, Wang Y1,3.

Author information

1
State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China.
2
Department of Hepatobiliary Surgery, Zhujiang Hospital, Guangzhou, China.
3
Southern Medical University Biomedical Research Center, Southern Medical University, Guangzhou, China.

Abstract

BACKGROUND AND AIM:

Virological cure becomes available for most patients with chronic hepatitis C (CHC), but residual fibrosis can be an independent risk factor for liver-related complications. We aimed to characterize fibrosis change in CHC patients achieved virological cure.

METHODS:

We did a systematic literature search for studies that had pre and post-treatment evaluations of histologic fibrosis in CHC patients with sustained virological response (SVR). We identified the association of SVR with the incidence, extent, and velocity of fibrosis change.

RESULTS:

Overall, 3243 patients were included. Interferon-based regimens were used for all the patients, achieving a median SVR prevalence of 36.2%. Biopsy interval ranged from 1 to 10 years. Mean baseline fibrosis score (METAVIR) was 2.3 points. Compared with non-SVR patients, SVR patients could have higher incidence of fibrosis regression (35.1% vs 17.0%; OR: 3.3; P < 0.001), regardless of baseline fibrosis severity, way of biopsy evaluation, treatment regimen, or study design, and could have more extent of reduction (-0.31 points vs -0.00 points; P = 0.004). Baseline advanced fibrosis (F > 2) was associated with more rapid regression in both SVR and non-SVR patients (P < 0.05 for both). SVR patients could have lower incidence of fibrosis progression and maintenance than non-SVR patients by 4.8% versus 23.1% (OR: 0.20; P = 0.008) and 42.9% versus 55.2% (OR: 0.53; P < 0.001), respectively.

CONCLUSIONS:

There could be a favorable characteristic of fibrosis regression in SVR patients. However, residential fibrosis may remain an issue because of a non-ignorable prevalence of fibrosis maintenance among these patients.

KEYWORDS:

fibrosis; hepatitis C; liver biopsy; meta-analyses; sustained virological response

PMID:
27503423
DOI:
10.1111/jgh.13500
[Indexed for MEDLINE]

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