Antiviral therapy of liver cirrhosis due to chronic hepatitis C with interferon

Противовирусная терапия цирроза печени в исходе хронического гепатита С препаратами интерферона
Kakharman Yesmembetov 1, Nurgul Yesmembetova 2
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1 JSC «National Scientific Center for oncology and transplantlogy», General therapy department, Astana, Kazakhstan
2 South Kazakhstan Regional Oncology Center, Department of ultrasound diagnostics, Shymkent, Kazakhstan
J CLIN MED KAZ, Volume 4, Issue 38, pp. 21-24.
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ABSTRACT

1/3 of patients with chronic hepatitis C develop liver cirrhosis in 20 to 30 years’ time in the absense of effective antiviral therapy. By eradicating HCV, antiviral therapy with interferon allows to stop further progression of the liver disease, thereby reducing the risk of decompensation, hepatocellular carcinoma and liver-related death. Priority in starting antiviral therapy in chronic hepatitis C cases should be given to patients with fibrosis stages 3-4 (by METAVIR), with the highest risk of liver-related complications.
However, need of antiviral therapy in patients with HCV-induced cirrhosis is restricted by lower efficasy and a high risk of side effects. Randomised studies show, that antiviral therapy of patients with genotype 2/3 HCV-induced cirrhosis with interferon is as effective as in ones with chronic hepatitis, this way allowing it for all patients in stages A-B by Child score. Antiviral therapy of patients with decompensated liver cirrhosis, especially those with genotype 1 HCV, should be carefully weighed against the low efficasy and high risk of, in some cases life-threatening, side effects. Thus, antiviral therapy of patients with sub- and decompensated HCV-induced liver cirrhosis with interferon should be restricted to clinical centres, able to adequately address possible complications (variceal bleeding, ascitis, anemia, severe infection, hepatic encephalopathy, hepatorenal and hepatopulmonary syndrome) and perform TIPS and liver transplantation.

CITATION

Yesmembetov K, Yesmembetova N. Antiviral therapy of liver cirrhosis due to chronic hepatitis C with interferon. Journal of Clinical Medicine of Kazakhstan. 2015;4(38):21-4.

REFERENCES

  • Lavanchy D. The global burden of hepatitis C. Liver Int, 2009, No.29 Suppl 1, pp.74–81.
  • Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiologyof hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence, Hepatology, 2013, No. 57(4), pp.1333–42.
  • Tong MJ, el-Farra NS, Reikes AR, Co RL. Clinical outcomes after transfusionassociated hepatitis C. New Engl J Med, 1995, No. 332(22), pp.1463–6.
  • Tremolada F, Casarin C, Alberti A, Drago C, Tagger A, Ribero ML, et al. Long-term follow-up of non-A, non-B (type C) posttransfusion hepatitis. J Hepatol, 1992, No.16(3), pp.273–81.
  • El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology, 2007, No. 32(7), pp.2557–76.
  • Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology, 2008, No. 48(2), pp.418–31.
  • Sangiovanni A, Prati GM, Fasani P, Ronchi G, Romeo R, Manini M, Del Ninno E, Morabito A, Colombo M. The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients, Hepatology, 2006, Jun; No. 43(6), pp.1303-10.
  • Nishiguchi S, Kuroki T, Nakatani S. et al. Randomised trial of effects of interferon-alpha on incidence of hepatocellular carcinoma in chronic active hepatitis C with cirrhosis, Lancet, 1995, No.346, pp.1051–5.
  • Morgan TR, Ghany MG, Kim HY. et al. Outcome of sustained virological responders with histologically advanced chronic hepatitis C. Hepatology, 2010, No.52, pp.833–44.
  • Ogawa E, Furusyo N, Kajiwara E. et al. Efficacy of pegylated interferon alpha- 2b and ribavirin treatment on the risk of hepatocellular carcinoma in patients with chronic hepatitis C: a prospective, multicenter study. J Hepatol, 2013, No.58, pp. 495–501. 
  • European Association for Study of Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol, 2014 Feb, No.60(2), pp.392-420.
  • Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr, Häussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med, 2002, Sep 26, No.347(13), pp.975-82.
  • Manns MP, McHutchison JG, Gordon SC, Rustgi VK. et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet, 2001, Sep 22, No.358 (92), pp.958-65.
  • Hadziyannis SJ, Sette H Jr, Morgan TR, Balan V, Diago M. et al. PEGASYS International Study Group. Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med, 2004 Mar 2, No.140(5), pp.346-55.
  • Heathcote EJ, Shiffman ML, Cooksley WG, Dusheiko GM, Lee SS. et al. Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis. N Engl J Med, 2000 Dec 7, No.343(23), pp.1673-80.
  • Di Marco V, Almasio PL, Ferraro D, Calvaruso V, Alaimo G, Peralta S, Di Stefano R, Craxì A. Peg-interferon alone or combined with ribavirin in HCV cirrhosis with portal hypertension: a randomized controlled trial. J Hepatol. 2007, Oct, No.47(4), pp.484-91.
  • Iacobellis A, Siciliano M, Perri F, Annicchiarico BE, Leandro G. et al. Peginterferon alfa-2b and ribavirin in patients with hepatitis C virus and decompensated cirrhosis: A controlled study. Journal of Hepatology, 2007; No.46(2), pp. 206–212.
  • Carrión JA, Martínez-Bauer E, Crespo G, Ramírez S. et al. Antiviral therapy increases the risk of bacterial infections in HCVinfected cirrhotic patients awaiting liver transplantation: A retrospective study. J Hepatol, 2009 Apr, No.50(4), pp.719-28.
  • Vezali E, Aghemo A, Colombo M. A review of the treatment of chronic hepatitis C virus infection in cirrhosis. Clin Ther, 2010 Dec, No.32(13), pp.2117-38.
  • Everson GT, Trotter J, Forman L, Kugelmas M, Halprin A, Fey B, Ray C. Treatment of advanced hepatitis C with a low accelerating dosage regimen of antiviral therapy. Hepatology, 2005, No. 42 (2), pp.255–262.
  • Wiesner RH, Sorrell M, Villamil F; International Liver Transplantation Society Expert Panel. Report of the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C. Liver Transpl, 2003 Nov, No.9(11), pp.1-9.