title: Long term changes in liver histology following treatment of chronic hepatitis C virus.
abstract: OBJECTIVE
  The histologic hallmarks of chronic HCV include inflammation and fibrosis. The impact of interferon therapy on liver histology was evaluated.
  
  
  METHODS
  The study population consisted of 348 patients with chronic HCV who underwent a baseline liver biopsy, received either no treatment or a single course of interferon based therapy, were followed for 5 years without any treatment or additional treatment and then underwent a repeat liver biopsy. The patients were divided into 3 groups; deferred treatment (NoTx = 47), received interferon based therapy but failed to achieve SVR (NoSVR = 189) and achieved SVR (SVR = 112).
  
  
  RESULTS
  Patients with NoTx and NoSVR had significant increases in mean inflammation scores (from 4.3 to 6.3 and 5.4 to 6.7 respectively; p < 0.001 for both) and fibrosis scores (from 0.9 to 1.8 and 1.9 to 2.5; p < 0.001 for both). The amounts by which inflammation, fibrosis and rate of fibrosis progression increased were not significantly different between the two groups. Increases in total inflammation and the piecemeal necrosis sub-score over time were strongly associated with fibrosis progression. Patients with SVR had a significant decline in mean inflammation and fibrosis scores (from 6.7 to 2.2 and 3.3 to 1.8; p < 0.001 for both); 40% of patients resolved all fibrosis and 50% of patients resolved cirrhosis.
  
  
  CONCLUSIONS
  Increases in inflammation are associated with fibrosis progression and in the absence of SVR interferon treatment does not appear to affect the long term natural history of this process. Patients with SVR have resolution of inflammation and fibrosis and many resolve cirrhosis.
authors.affiliation: Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, Virginia, USA.
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.affiliation: Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Contos
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hubbard
authors.affiliation: Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, Virginia, USA.
authors.forename: April
authors.initials: A
authors.lastname: Long
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.affiliation: Hepatology Section Division of Surgical Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a