ORIGINAL ARTICLE   

Minerva Medica 2019 October;110(5):401-9

DOI: 10.23736/S0026-4806.19.06108-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Clinical outcomes in chronic hepatitis C long-term responders to pre-direct antiviral agents: a single-center retrospective study

Chiara ROSSO ¹ ✉, Gian Paolo CAVIGLIA ¹, Michela CIRUOLO ¹, Alessia CIANCIO ¹, Ramy YOUNES ¹, Antonella OLIVERO ¹, Chiara GIORDANINO ², Giulia TROSHINA ¹, Maria Lorena ABATE ¹, Mario RIZZETTO ¹, Rinaldo PELLICANO ², Giorgio M. SARACCO ¹, Elisabetta BUGIANESI ¹, Antonina SMEDILE ¹

¹ Division of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy; ² Department of Gastro-Hepatology, Città della Salute e della Scienza University Hospital, Turin, Italy

BACKGROUND: Obesity, type 2 diabetes (T2D), dyslipidemia, arterial hypertension as well as hepatic steatosis (HS) are common conditions that can affect clinical outcomes of patients with chronic hepatitis C (CHC) who achieved sustained virologic response (SVR). The aim of this study was to assess the impact of metabolic cofactors on the occurrence of clinical events during follow-up (FU) in a group of CHC long-term responders (LTRs) to interferon- (IFN) based therapy.
METHODS: A total of 5172 medical records of CHC patients enrolled from 1990 to 2011 were examined; 1034 of 5172 (20%) patients were treated with IFN-based therapy and 382 of 1034 (37%) of them achieved SVR. A total of 188 (49%) LTRs underwent liver biopsy before antiviral treatment. Data on liver and cardiometabolic events such as cirrhosis and its complications, hepatocellular carcinoma, coronary artery disease, arterial hypertension, impaired fasting glucose (IFG)/type 2 diabetes (T2D) and dyslipidemia, were collected over time.
RESULTS: The mean age of the whole cohort was 46±12 years and 114/188 (61%) patients were males. HS was found in 82 of 188 (43.6%) patients and most of them were infected by HCV genotype 3a. The prevalence of obesity, IFG/T2D, dyslipidemia and arterial hypertension was 4.3%, 6.9%, 37.2%, and 5.9%, and was similarly distributed among patients with and without HS. Cirrhosis was histologically diagnosed in 18 of 188 (9.6%) patients. After a median follow-up of 11 years (range 3-21 years), the cumulative incidence of cardiovascular events, IFG/T2D and dyslipidemia was higher in CHC-LTRs who had HS at baseline compared to those without HS (1.2%, 2.3%, and 3.0% vs. 0.4%, 0.8%, and 2.5%, respectively). At multivariable Cox regression analysis, HS was significantly associated to the development of cardiovascular events and IFG/T2D (HR=5.2, 95% CI: 1.3-20.7, P=0.019, and HR=2.6, 95% CI: 1.1-6.2, P=0.027, respectively).
CONCLUSIONS: In CHC-LTRs, HS at baseline may predispose to the development of cardiovascular events and T2D during follow-up emphasizing the importance of an accurate counseling in order to prevent extra-hepatic complications.

KEY WORDS: Hepacivirus; Enzyme activation; Metabolism; Fatty liver