American Association for the Study of Liver Diseases
53rd Annual Meeting and Postgraduate Course
Boston, MA
November 1-5, 2002
Temporary Abstract ID: 100347
Correspondent: Bennet Cecil

SUCCESSFUL ANTIVIRAL THERAPY OF PATIENTS WITH HCV CIRRHOSIS SAVES LIVES
Bennet Downs Cecil, Hepatitis C Treatment Centers INC, Mary Lavelle, Louisville VAMC
HCV is a major cause of death in US military veterans, and cirrhosis is a common cause of death in middle aged Americans.1 The authors began treating HCV infected veterans at the Louisville VA in May 1998 using interferon plus ribavirin. We have treated 298 veterans, and 23% of our first 97 patients had a sustained viral response.2 The first author has treated an additional 1,100 HCV infected patients at the Hepatitis C Treatment Center in Louisville, KY since December 1998. We report the survival experience of our 177 patients (56 VAMC, 121 HCTC) with advanced liver damage (stage 3 or 4 fibrosis on biopsy, or clinical evidence of cirrhosis). We use an aggressive “intention to cure” approach, with the goal of curing all HCV infected patients. We offer antiviral treatment to patients with compensated or decompensated HCV cirrhosis.3 We reported the details of our treatment method elsewhere.2,4 Figure one is a Kaplan Meier curve of the 177 patients, grouped by presence or absence of sustained viral response. Sustained viral responders have an improved survival compared with the others (Breslow-Gehan-Wilcoxon Chi-Square= 4.340, P= 0.0372 The only liver related death was a female who developed HCC while on antiviral treatment. She was a sustained viral responder but died from HCC 2.3 years after starting treatment. Thirty percent of cirrhotic non sustained responders were dead within 2 years of starting antiviral therapy. Our experience provides evidence that curing HCV in patients with advanced liver damage improves survival. The mortality rate is high in those who do not become sustained responders.

1. Bennet D. Cecil, Mary Lavelle. Causes of death in 93 US veterans with hepatitis C. AASLD abstract 6488 Gastroenterology 118 No 4 Suppl 2 part 2 of 2 2. Poster Presentation AASLD 2001 Dallas Texas. Bennet Cecil, Mary Lavelle. Individualized hepatitis C therapy of military veterans: Interferon dose escalation improves the sustained response rate. 3. Bennet Cecil, Tami Hill, Mary Lavelle Decompensated hepatitis C cirrhotic patients can be safely treated with titrated doses of interferon and ribavirin; they have a highly significant HCV-RNA response to treatment. Supplement to Hepatology, 30, No. 4 Pt 2 2000 AASLD abstract1570 4. Bennet Cecil. Individualized Antiviral therapy Using Viral Kinetics for Hepatitis C Patients. Louisville Medicine 2001 July; 49 (2):83-84
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