title: Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus-induced cirrhosis. A 12-year prospective follow-up study.
abstract: The incidence of de novo development of esophageal varices (EV) in patients with compensated liver cirrhosis has been determined by few studies in the short term and never in the long term. The aims of the present study were to determine the incidence and the risk factors associated with the development of EV and to assess whether antiviral treatment and achievement of sustained virologic response (SVR) may prevent de novo EV development in patients with HCV-induced cirrhosis. We studied 218 patients with compensated EV-free, HCV-induced cirrhosis consecutively enrolled between 1989 and 1992 at three referral centers in Milan, Italy. Endoscopic surveillance was performed at 3-year intervals according to international guidelines. SVR was defined as undetectable serum HCV-RNA 24 weeks after treatment discontinuation. During a median follow-up of 11.4 years, 149/218 (68%) patients received antiviral treatment and 34 (22.8%) achieved SVR. None of the SVR patients developed EV compared with 22 (31.8%) of the 69 untreated subjects (P < 0.0001) and 45 (39.1%) of the 115 non-SVR patients (P < 0.0001). On multivariate analysis, HCV genotype 1b (hazard ratio [HR] 2.40; 95% confidence interval [CI] 1.17-4.90) and baseline model for end-stage liver disease (MELD) score (HR 1.20; 95% CI 1.07-1.35 for 1 point increase) were independent predictors of EV.
  
  
  CONCLUSIONS
  In the long term, the achievement of SVR prevents the development of EV in patients with compensated HCV-induced cirrhosis. Therefore, in these patients, endoscopic surveillance can be safely delayed or avoided. Genotype 1b infection and MELD score identify the subset of patients at higher risk of EV development who need tailored endoscopic surveillance.
authors.affiliation: Department of Internal Medicine, A.O. Fatebenefratelli e Oftalmico, Milan, Italy. savino.bruno@fbf.milano.it
authors.forename: Savino
authors.initials: S
authors.lastname: Bruno
authors.forename: Andrea
authors.initials: A
authors.lastname: Crosignani
authors.forename: Corinna
authors.initials: C
authors.lastname: Facciotto
authors.forename: Sonia
authors.initials: S
authors.lastname: Rossi
authors.forename: Luigi
authors.initials: L
authors.lastname: Roffi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Redaelli
authors.forename: Roberto
authors.initials: R
authors.lastname: de Franchis
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents