title: Association of sustained virologic response with reduced progression to liver cirrhosis in elderly patients with chronic hepatitis C.
abstract: OBJECTIVE
  We studied the effect of sustained virologic response (SVR) after treatment with pegylated-interferon (PEG-IFN) plus ribavirin on the development of liver cirrhosis in elderly patients with chronic hepatitis C (CHC).
  
  
  METHODS
  This retrospective study enrolled 145 elderly CHC patients (aged ≥65 years) who were treatment-naïve and were treated with PEG-IFN plus ribavirin for 6 months between January 2005 and December 2011. Abdominal sonography was performed and liver biochemistry was studied at baseline, at the end of treatment, and every 3-6 months thereafter. The development of liver cirrhosis and related complications was evaluated at the follow-ups. The aspartate aminotransferase-to-platelet ratio index was used as a noninvasive maker for fibrosis.
  
  
  RESULTS
  The mean patient age was 69.1±3.3 years, and the average follow-up time was 5.5 years (standard deviation: 2.5 years, range: 1.1-12.3 years). Ninety-five patients (65.5%) achieved SVR, and 26 (17.9%) discontinued treatment. Twenty-seven patients (18.6%) developed liver cirrhosis after treatment. Patients without SVR had significantly greater risk of liver cirrhosis than those with SVR (hazard ratio [HR]: 3.39, 95% confidence interval [CI]: 1.312-8.761, P=0.012). The difference in 3-year cumulative incidence of liver cirrhosis was 24.8% greater for patients without SVR (35.2%, 95% CI: 13.0-57.5, P=0.012) compared with those with SVR (10.4%, 95% CI: 3.1-17.7). There was a trend of a higher baseline aspartate aminotransferase-to-platelet ratio index score in patients who progressed to liver cirrhosis compared with those who did not progress (2.1±1.2 vs 1.6±1.3, P=0.055), but the difference failed to reach significance by Cox regression (adjusted HR: 1.285, 95% CI: 0.921-1.791, P=0.14).
  
  
  CONCLUSIONS
  An SVR following PEG-IFN combination treatment can reduce the risk of liver cirrhosis in elderly CHC patients.
authors.affiliation: Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzuchi University, Hualien, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tseng
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Infectious Disease and Signaling Research Center, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Ting-Tsung
authors.initials: TT
authors.lastname: Chang
authors.affiliation: Department of Agronomy, National Chiayi University, Chia-Yi, Taiwan.
authors.forename: Shinn-Jia
authors.initials: SJ
authors.lastname: Tzeng
authors.affiliation: Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzuchi University, Hualien, Taiwan.
authors.forename: Yu-Hsi
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzuchi University, Hualien, Taiwan.
authors.forename: Tsung-Hsing
authors.initials: TH
authors.lastname: Hung
authors.affiliation: Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
authors.forename: Hsiang-Ting
authors.initials: HT
authors.lastname: Huang
authors.affiliation: Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan.
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzuchi University, Hualien, Taiwan.
authors.forename: Kuo-Chih
authors.initials: KC
authors.lastname: Tseng
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D013624:Taiwan; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin
keywords: hepatitis C; liver cirrhosis; pegylated interferon; ribavirin; sustained virologic response