title: Slow regression of liver fibrosis presumed by repeated biomarkers after virological cure in patients with chronic hepatitis C.
abstract: OBJECTIVE
  Chronic hepatitis C is both a virologic and fibrotic disease and complications can occur in patients with sustained virologic response (SVR) with residual fibrosis. Due to the limitations of repeated biopsies, no studies have assessed the dynamic of fibrosis before and after treatment. Using biopsy as reference, FibroTest™ has been validated as a biomarker of fibrosis progression and regression, with similar prognostic values. The aim was to estimate the impact of SVR on the dynamic of fibrosis presumed by FibroTest™.
  
  
  METHODS
  In a prospective cohort, the main end point was the 10-year regression rate of fibrosis, defined as a minimum 0.20 decrease in FibroTest™, equivalent to one METAVIR stage.
  
  
  RESULTS
  A total of 933 patients with both repeated FibroTest™ and transient elastography were included. At 10 years, among the 415 patients with baseline advanced fibrosis, 49% (95% CI 33-64%) of the 108 SVR had a regression, which was greater than in the 219 non-responders [23% (14-33%; p < 0.001 vs. SVR)] and not lower than in the 88 non-treated [45% (10-80%; p = 0.39 vs. SVR)] patients. In all 171 SVR, cirrhosis regressed in 24/43 patients, but 15 new cirrhosis cases occurred out of 128 patients, that is only a net reduction of 5.3% [(24-15) = 9/171); (2.4-9.8%)]. Four cases of primary liver cancer occurred in SVR [4.6% (0-9.8)], and 13 in non-responders [5.6% (1.5-9.8); p = 0.07].
  
  
  CONCLUSIONS
  In patients with chronic hepatitis C, and as presumed by FibroTest™, virological cure was associated with slow regression of fibrosis 10years later, a disappointing 5% decrease in cirrhosis cases, and a remaining 5% risk of primary liver cancer.
authors.affiliation: Assistance Publique Hôpitaux de Paris (AP-HP), University Pierre Marie Curie (UPMC), Liver Center, Paris, France. Electronic address: tpoynard@teaser.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
authors.forename: Joseph
authors.initials: J
authors.lastname: Moussalli
authors.forename: Mona
authors.initials: M
authors.lastname: Munteanu
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Pascal
authors.initials: P
authors.lastname: Lebray
authors.forename: Marika
authors.initials: M
authors.lastname: Rudler
authors.forename: Yen
authors.initials: Y
authors.lastname: Ngo
authors.forename: Vincent
authors.initials: V
authors.lastname: Thibault
authors.forename: Helmi
authors.initials: H
authors.lastname: Mkada
authors.forename: Frederic
authors.initials: F
authors.lastname: Charlotte
authors.forename: Françoise Imbert
authors.initials: FI
authors.lastname: Bismut
authors.forename: Olivier
authors.initials: O
authors.lastname: Deckmyn
authors.forename: Yves
authors.initials: Y
authors.lastname: Benhamou
authors.forename: Marc Antoine
authors.initials: MA
authors.lastname: Valantin
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D060085:Coinfection / Q000473:pathology; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000998:Antiviral Agents
keywords: Cirrhosis; Elastography; FibroSure; FibroTest™