title: Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders.
abstract: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated.
  
  
  
  To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients.
  
  
  
  Patients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review.
  
  
  
  A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility.
  
  
  
  As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
authors.affiliation: San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA.
authors.forename: Myrna L
authors.initials: ML
authors.lastname: Cozen
authors.affiliation: San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Ryan
authors.affiliation: San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.affiliation: Palo Alto VA Medical Center and Stanford University, 3801 Miranda Ave, GI/Hepatology #154C, Palo Alto, CA, 94304-1207, USA.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.affiliation: Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kaplan
authors.affiliation: Minneapolis VA Medical Center, 1 Veterans Drive, GI, Minneapolis, MN, 55417, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Pocha
authors.affiliation: Bronx VA Medical Center, 130 W. Kingsbridge Rd, Bronx, NY, 10468, USA.
authors.forename: Norbert
authors.initials: N
authors.lastname: Brau
authors.affiliation: New York Harbor Brooklyn and Manhattan VA Medical Centers, 800 Poly Pl, Brooklyn, NY, 11209, USA.
authors.forename: Ayse
authors.initials: A
authors.lastname: Aytaman
authors.affiliation: Iowa City VA Medical Center and the University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
authors.forename: Warren N
authors.initials: WN
authors.lastname: Schmidt
authors.affiliation: Boston VA Health Care System and AbbVie Pharmaceuticals, 85 E. Concord St. #7700, Boston, MA, 02118, USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: Pedrosa
authors.affiliation: Houston VA Medical Center and Baylor University, Digestive Disease Section, #111D, 2002 Holcombe Blvd, Houston, TX, 77030-4211, USA.
authors.forename: Bhupinderjit S
authors.initials: BS
authors.lastname: Anand
authors.affiliation: Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA.
authors.forename: Kyong-Mi
authors.initials: KM
authors.lastname: Chang
authors.affiliation: Long Beach VA Medical Center and University of California Irvine, #111G, 5901 E. 7th Street, Long Beach, CA, 90822-5201, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Morgan
authors.affiliation: San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA. Alexander.Monto@va.gov.
authors.forename: Alexander
authors.identifier: 0000-0002-2710-6871
authors.initials: A
authors.lastname: Monto
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
chemical_list: D016898:Interferon-alpha; D012254:Ribavirin
keywords: Cirrhosis; Hepatitis C; Hepatitis C therapy; Hepatocellular carcinoma; Survival