The long-term prospective study of patients with liver cirrhosis after elimination of the hepatitis C virus

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Abstract

Aim. To study liver function and portal hypertension, incidence and risk factors of liver-related complications, including hepatocellular carcinoma (HCC), in patients with HCV-related liver cirrhosis achieved sustained virologic response (SVR) after direct-acting antiviral therapy.

Materials and methods. Patients with HCV-related liver cirrhosis were followed up after achievement SVR with assessment of liver function parameters, portal hypertension, Model for End-stage Liver Disease (MELD) and Сhild – Pugh (CP) scores, complications development, including HCC, every 3–6 months. The median follow-up duration was 24 [18; 30] months after end of treatment.

Results. At last observation, a number of cirrhotic patients with CP class A increased from 72% to 85%, with CP class B reduced from 23.5% to 12.5%, with CP class C – from 4.5% to 2.5%. In 89% patients were identified a regress of liver fibrosis (from 23.5 [16.9; 28] to 15.0 [10.2; 21.3] kPa, p<0.005), each third patient – reduction of fibrosis stage to F2/F3. In 19 (9.5%) patients were occurred liver-related complications, including HCC (in 9 patients). Baseline high total bilirubin level (≥34 µmol/l) (Hazard ratio (HR) 11.5, 95% confidence interval (CI) 2.3–57.8, р<0.005) and ascites (HR=17.6, 95% CI 2.1–144.8, p=0.008) were independent risk factors associated with HCC development.

Conclusion. The risk of HCC development remains in patients with HCV-related liver cirrhosis, despite on eradication of hepatitis C virus. Therefore, these patients should continue to undergo more intensive examination (ultrasound examination and determination of alfa-fetoprotein level each 3–6 months), including contrast-enhanced methods of imaging, the frequency of which should be determined.

About the authors

E. A. Nabatchikova

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: e.nabat4ikova@gmail.com
ORCID iD: 0000-0003-4534-7991

аспирант каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

D. T. Abdurakhmanov

Sechenov First Moscow State Medical University (Sechenov University)

Email: e.nabat4ikova@gmail.com

д.м.н., проф. каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

E. N. Nikulkina

Sechenov First Moscow State Medical University (Sechenov University)

Email: e.nabat4ikova@gmail.com

ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

T. P. Rozina

Sechenov First Moscow State Medical University (Sechenov University); Lomonosov Moscow State University

Email: e.nabat4ikova@gmail.com

к.м.н., доц. каф. внутренних, профессиональных болезней и ревматологии; доц. каф. внутренних болезней факультета фундаментальной медицины.

Russian Federation, Moscow

E. L. Tanaschuk

Sechenov First Moscow State Medical University (Sechenov University)

Email: e.nabat4ikova@gmail.com

к.м.н., ассистент каф. внутренних, профессиональных болезней и ревматологии

Russian Federation, Moscow

N. V. Nikiforova

Sechenov First Moscow State Medical University (Sechenov University)

Email: e.nabat4ikova@gmail.com

зав. отд-нием гепатологии Клиники ревматологии, нефрологии и профессиональных болезней им. Е.М. Тареева

Russian Federation, Moscow

V. S. Adonyeva

Botkin City Hospital

Email: e.nabat4ikova@gmail.com

зав. областным гепатологическим центром БУЗ Орловской области

Russian Federation, Orel

S. V. Moiseev

Sechenov First Moscow State Medical University (Sechenov University); Lomonosov Moscow State University

Email: e.nabat4ikova@gmail.com

д.м.н., проф., зав. каф. внутренних, профессиональных болезней и ревматологии; проф. каф. внутренних болезней факультета фундаментальной медицины

Russian Federation, Moscow

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