cirrhosis

Patients with cirrhosis are the ones in danger of premature death from HCV. After infection with HCV for

20 years about 20% of patients have cirrhosis. After 50 years of infection, about half of HCV patients have

cirrhosis. About 4% of patients with HCV cirrhosis develop liver failure each year and about 1% develop liver

cancer. Cirrhotic patients therefore have about 95% chance of remaining stable each year. Once liver

failure or liver cancer occurs, about half of the patients die in one or two years. Liver transplantation can

be done but the list is long and patients still have an appreciable death rate. About 12% of transplanted

patients die the first year and 25% die by five years. The new liver is infected with HCV and sometimes

progresses to cirrhosis very quickly. Some transplant patients are cured of HCV before or after transplant,

using antiviral therapy. Be sure to read my page on survival about the benefits of curing HCV in patients

with cirrhosis and even those with liver failure.

Patients infected with HCV start with no fibrosis, stage 0. They develop mild fibrosis, stage 1, after a few years.

Later, moderate fibrosis, stage 2, occurs. Many patients will advance to stage 3 fibrosis where the biopsy shows

bridging fibrosis also called incomplete cirrhosis. Patients with fully developed cirrhosis have their normal liver

architecture destroyed and replaced with regenerative nodules. These nodules are composed of liver cells surrounded

by bands of scar tissue.

The HALT-C Trial Group reported their results treating patients with cirrhosis or bridging fibrosis (stage 4

or 3). Thirty-five percent of patients had no detectable HCV RNA in serum at treatment week

20, and 18% achieved sustained virologic response (SVR). To get into the study, you had to fail regular

interferon or interferon plus ribavirin. They used Pegasys plus ribavirin. The addition of telaprevir to Pegasys

plus ribavirin has greatly improved the success of antiviral therapy to about 60% in untreated genotype one

and perhaps 40% of nonresponders to previous treatment.