Clinical outcomes of direct-acting antiviral therapy in patients with compensated hepatitis C virus-related cirrhosis

Abstract

Background and Aims: Our aim is to assess the clinical impact of direct-acting antiviral treatment in patients with compensated hepatitis C virus-related cirrhosis after one year of follow-up. Methods: Data from 129 patients with compensated cirrhosis who were treated at our center with direct-acting antivirals between January and October 2015was retrospectively analyzed. Only patients with a follow-up of at least 12 months were included. We analyzed: evolution of liver function (Child-Pugh, MELD), development of hepatocellular carcinoma and clinical decompensations (ascites, gastrointestinal bleeding, encephalopathy, jaundice). Results: By intention to treat, 94.6% patients achieved sustained virologic response. 90 patients completed 12 months of follow-up and were included: 73.3% were men, 37.8% were naive, and 11% had liver graft cirrhosis. The most frequent genotype was 1b (52.2%). 75.6% of patients were treated for 12 weeks. The most frequent combination was sofosbuvir/ledipasvir (35.5%) and 66.7% of patients received ribavirin. 6.7% of patients had relevant adverse effects: three anemias, one severe asthenia, one purpura requiring corticosteroids and one case of acute on chronic liver failure. Four patients (4.4%) suffered a decompensation during the follow-up: one patient with non-malignant portal thrombosis developed ascites, one patient with a history of ascites developed an acute on chronic liver failure, and two patients developed ascites coinciding with the diagnosis of hepatocellular carcinoma. Five patients (5.5%) developed hepatocellular carcinoma. In one case, a suspicious lesion was detected before treatment and another patient had a post-transplant recurrence (explant: 6 carcinomas and microvascular invasion). The incidence of de novo hepatocellular carcinoma was 3.3%. Regarding hepatic function: 6.6% of patients improved MELD score more than one point, 72.1% showed no differences or ± one point and 11.1% of patients it worsened more than one point. 87.7% of patients stayed in stage A of Child-Pugh score at the end of the follow up and 3.3% worsened to Child B. Conclusions: In our sample, direct acting antiviral treatmentwas not associated with a substantial difference in the hepatic decompensation rate (4.4%) or in the incidence of hepatocellular carcinoma (3.3%) in the first year of follow-up compared to what it is described in the literature for untreated compensated cirrhotic patients.