Clinical

Protracted antiviral therapy improves liver function in HCV-related cirrhosis

Last Updated: 2007-10-31 17:59:32 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Prolonging antiviral therapy improves residual liver function in patients with cirrhosis related to hepatitis C virus (HCV) infection, according to a report from Italy in the September 28th issue of the World Journal of Gastroenterology.

"HCV-related liver cirrhosis is probably an illness partially reversible, so it is physician's commitment to try to reverse or slow down its progression," Dr. Giovanni Tarantino told Reuters Health.

Dr. Tarantino from Federico II University Medical School of Naples and colleagues investigated the impact of long-term, moderate-dose antiviral treatment on progression of liver cirrhosis in 35 patients with HCV-related liver cirrhosis, compared with 36 similar patients who did not receive antiviral therapy.

Dr. Tarantino explained that it is necessary, in his group's opinion, to evaluate the therapeutic effect of antiviral therapy with "real" (rather than surrogate) liver function tests, such as "caffeine clearance or the simple version (TOSCA) and non-invasive parameters of portal hypertension (i.e., Resistivity Index of Splenic Artery by ultrasound (SARI)."

Depending on their baseline classification, 25% to 36% of antiviral-treated cirrhotic patients showed at least a 20% improvement in liver function as measured by TOSCA, the team reports.

None of the treated patients showed a worsening of liver function, but 14% of untreated patients had a deterioration of TOSCA.

Portal hypertension (as measured by SARI) improved at least 20% in half the treated patients who had baseline and follow-up evaluations, the investigators say, but HCV viral clearance was achieved in only a handful of treated patients.

"A prolonged combined antiviral course at reduced dose may slow down the progression of liver disease to cirrhosis," the authors conclude.

"In the same patients, we are trying to prolong the period of therapy in order to better assess the eventual improvement of the residual liver function," Dr. Tarantino added.

World J Gastroenterol 2007;13:4903-4908.