title: Interferon-based therapy delays but metabolic comorbidity accelerates progression of chronic hepatitis C.
abstract: BACKGROUND
  We compared mortality and complications of chronic hepatitis C between treated and untreated Mexican patients after long-term follow-up. We used a time-to-event analysis and identified the prognostic factors.
  
  
  METHODS
  Seventy-four patients with chronic hepatitis C were studied. They were ≥ 18 years of age and had a molecular diagnosis of chronic hepatitis C and ≥ 6 months of follow-up. Patients with neoplasia or those infected with human immunodeficiency virus or hepatitis B Virus were excluded. Kaplan-Meier analysis, log-rank test, annualized incidence per 100 person-years, and stepwise discriminant analysis were used to analyse mortality and complications.
  
  
  RESULTS
  The end-point of annualized incidence was lowest in sustained virological responders, intermediate in non-responders, and highest in untreated patients. The absence of treatment impacted adversely on cirrhosis development and the occurrence of portal hypertension and hepatic decompensation/hepatocellular carcinoma (logrank, p < 0.05). Diabetes impacted adversely on liver-related death/liver transplantation among untreated patients. Stepwise discriminant analysis showed that diabetes, high blood pressure, and no retreatment predicted cirrhosis development (eigenvalue ≥ 0.8; p < 0.05). A MELD score ≥ 18 and age ≥ 50 years predicted hepatic decompensation/hepatocellular carcinoma (eigenvalue < 0.8; p < 0.05). APRI ≥ 1.5 predicted mortality/liver transplantation and liver-related death/liver transplantation (eigenvalue < 0.8; p < 0.05).
  
  
  CONCLUSIONS
  This is the first long-term study of chronic hepatitis C among Mexican patients. Treated patients showed less progression of liver disease. Treated patients showed less progression of liver disease; and older patients, those with metabolic comorbidities, with MELD score ≥ 18 and APRI ≥ 1.5 exhibited adverse effects.
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Martínez-Macías
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Paula
authors.initials: P
authors.lastname: Cordero-Pérez
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Juárez-Rodríguez
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Carlos Y
authors.initials: CY
authors.lastname: Chen-López
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Martínez-Carrillo
authors.affiliation: University Hospital, Pathology Service, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Alarcón-Galván
authors.affiliation: Informatics Department, UANL School of Biology. Monterrey, Nuevo León, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mercado-Hernández
authors.affiliation: University Hospital, Liver Unit, UANL. Monterrey, Nuevo León, Mexico.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Muñoz-Espinosa
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D048550:Hepatic Insufficiency / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D006975:Hypertension, Portal / Q000209:etiology; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology; D008113:Liver Neoplasms / Q000209:etiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*
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