The management of both compensated and decompensated progressed to cirrhosis is estimated to be 20% to 30%. 1 In addition to patients who present with symptoms or signs cirrhosis caused by hepatitis C must be viewed in the context of the natural history of the disease. The prognosis of compen-of chronic hepatitis C, a proportion present initially with complications of cirrhosis such as variceal bleeding, ascites, sated cirrhosis caused by hepatitis C is relatively good. In a recent retrospective study, after 5 years of follow-up evalua-or hepatocellular carcinoma (HCC). For countries in North America and Europe with a prevalence of chronic HCV infec-tion, 18% of patients had developed hepatic decompensation and 7% hepatocellular carcinoma. Overall 5-year survival rate tion in the general population of 0.5% to 2%, one can estimate that at least 0.1% (1,000 per million) of the population was 91%. Treatment with alpha interferon appears to decrease the incidence of hepatocellular carcinoma in patients who have cirrhosis caused by hepatitis C.
Spontaneous resolution of disease and loss of viral replica-achieve a sustained remission. However, on an intention-totreat basis and after adjustment for differences in clinical tion is rare during the course of chronic hepatitis C. 2 Accordingly, patients with cirrhosis caused by HCV are likely to and serological features at entry, interferon therapy does not correlate with a reduced incidence of liver cancer or improved progress steadily, eventually developing complications of hepatic failure or HCC or require liver transplantation. Death survival. Combined analysis of multiple large studies on patients with cirrhosis caused by hepatitis C indicates that cur-from liver-related causes has been shown to account for 70% of the mortality in patients with cirrhosis caused by hepatitis rent regimens of alpha interferon (3 to 6 million units three times weekly for 6 to 12 months) result in a sustained bio-C, 3 compared with only 3% of patients overall with hepatitis C. 4 The patient with cirrhosis caused by hepatitis C consti-chemical response in 9% of patients. The rates of sustained virological responses are less well documented. Virological tutes an important therapeutic challenge.
The management of both compensated and decompen-measurements during therapy show that only 22% of patients become hepatitis C virus (HCV) RNA negative by 4 weeks sated cirrhosis should be viewed in the context of the natural history of the disease. Recent reports have suggested that and, thereafter, there is a high rate of breakthrough. In small studies, the combination of interferon and ribavirin leads to alpha interferon therapy may reduce the risk of HCC in patients with cirrhosis. 5 At the same time, interferon is rarely sustained biochemical and virological response rates of 21%, more than twice the rates achieved with interferon alone. The effective in inducing lasting remissions in patients with preexisting cirrhosis. Thus, the role of alpha interferon therapy prognosis of decompensated cirrhosis caused by hepatitis C is poor, with a 5-year survival rate of only 50%. The efficacy in the management of cirrhosis caused hepatitis C is controversial. of interferon in patients with decompensated cirrhosis is not well documented and its use cannot be recommended. In COMPENSATED CIRRHOSIS contrast, 5-year survival rates after liver transplantation for cirrhosis caused by hepatitis C is excellent, in the range of Natural History. The prognosis of compensated cirrhosis 70% to 80%. Recurrence of HCV infection occurs in more caused by hepatitis C has been assessed in a large retrospecthan 95% of patients, but in short-term follow-up studies, tive study by Fattovich et al. 3 on a cohort of 384 patients recurrence of cirrhosis and graft failure occurs in only 10% who were followed for a mean period of 5 years at seven of patients. (HEPATOLOGY 1997;26(Suppl 1):128S-132S.)
European university hospitals. All patients had biopsy-documented cirrhosis, anti-HCV in serum, abnormal serum ami-The availability of specific tests for diagnosis of hepatitis notransferase levels, and no previous complication of cirrho-C has shown that a large proportion of patients examined at sis. Other causes of liver disease were excluded. The 5-year referral centers for liver disease have chronic hepatitis C virus survival rate of this cohort was 91%; hepatic decompensation (HCV) infection. The percentage of such patients who have occurred in 18% and HCC in 7% of patients at 5 years (Fig. 1). Thus, in patients with well-compensated cirrhosis caused by hepatitis C, mortality is less than 10% and serious hepatic Abbreviations: HCV, hepatitis C Virus; HCC, hepatocellular carcinoma. From the Department of Hepatogastroenterology and Internal Medicine, Erasmus complications less than 20% over a 5-year period.