Liver Cirrhosis May Soon Be Partially Cured

In patients with compensated (early stage) hepatitis C virus-related cirrhosis, antiviral combined therapy is providing a promising rate of response, ending in viral clearance.

Liver cirrhosis is present in at least 10-20% of these hepatitis C-infected patients, with highly increasing healthcare and emotional costs. Unfortunately, post-therapy data on different aspects of the illness, such as the residual liver function, measured as Total Overnight Salivary Caffeine Assessment (TOSCA; a liver test of microsomal function), and hepatic hemodynamics to indirectly evaluate the portal hypertension, measured as the Resistive Index of Splenic Artery (SARI) using Doppler ultrasound, are still lacking, because to date only the survival rate and hepato-carcinoma appearance have been extensively studied.

Thirty-five cirrhotic patients (24 grade A5 and 11 grade A6 of the Child-Pugh classification system, used to assess illness severity), with active virus replication and treated for a mean period of three years with moderate doses of interferon-alpha and Ribavirin were compared in a recent study to a cohort of 36 patients with similar characteristics and without antiviral treatment. TOSCA was determined at the starting point and three times throughout the course of therapy after a mean period of one year. In the meantime, the SARI was only measured at the beginning and end of the study.

Thirteen treated patients in the study showed a considerable TOSCA improvement. A reduction greater than 20% on the SARI was obtained in eight of the patients with improved liver function. This previously abnormal Doppler ultrasound parameter demonstrated a distinct total decreasing tendency at the end of therapy. Hepatitis C virus clearance was achieved in four patients at a median period of eight months of combined therapy. In the cohort of non-treated cirrhotic patients, not only the considered parameters remained unchanged, but also three patients ended with a worse Child-Pugh score.

Dr. Tarantino and his colleagues from Federico II University Medical School (Naples, Italy), who performed the study, believe that moderate-dosed, prolonged antiviral therapy can make stable or ameliorate residual liver function, the entity of portal hypertension, and the compensation status, all at acceptable costs. In this way, more severe liver cirrhosis complications, such as variceal hemorrhage, the appearance of refractory ascites and advanced encephalopathy, are can be delayed, thereby prolonging the survival period of many patients. The investigators, however, still emphasize the need to evaluate individuals affected by liver cirrhosis using alternative, non-invasive, and easily repeatable parameters of outcome to better understand the progression of this illness.

The study was published in the September 28, 2007, issue of the World Journal of Gastroenterology.


Related Links:
Federico II University Medical School