Hepatic Fibrosis Regression in the Setting of Persistent Viremia in Chronic Hepatitis C: A Dual Biopsy Study
V Pattullo, EJ Heathcote, M Guindi. University of Toronto, Toronto, ON, Canada
Background: To identify predictors of hepatic fibrosis regression and determine the relationship between body mass index (BMI) and hepatic fibrosis regression by both quantitative and qualitative measures.
Design: All patients in clinic with chronic hepatitis C (CHC) without contraindications routinely undergo pretreatment liver biopsy. Patients with 2 liver biopsies between Jan 1991 and Dec 2008 were eligible for inclusion in this retrospective study. Factors potentially influencing hepatic fibrosis: body weight, body mass index (BMI) and antiviral treatment history and outcome were recorded. Biopsies were scored in a blinded fashion for necroinflammation, fibrosis (Ishak), steatosis, and for 8 qualitative features of fibrosis regression. Regression was defined as ≥2 stage fall in Ishak stage (Reg-I), or <2 stage fall in Ishak stage associated with a rise in qualitative regression score (Reg-Q). Univariate analysis was performed to determine the factors associated with hepatic fibrosis regression.
Results: 159 patients had complete clinical data and evaluable paired liver biopsies were available (genotype 1 81%, BMI 26.7+/- 5.6 kg/m2, treatment naïve 31%, sustained virological response (SVR) 11%). Mean biopsy lengths and were 1.8+/-0.6cm and 2.2+/-0.8cm, and mean number of portal tracts 15.8+/-6.2 and 17.6+/-7.2 at first and second biopsies respectively. The mean interval between biopsies was 5.4+/-3.1 years; the interval between SVR and second biopsy was similar to the biopsy interval in the persistently viremic (4.42+/-3.0 vs 5.17+/-2.9 years, p=0.78). Regression (by either definition) was noted in 38 patients (23.9%); Reg-I was observed in 12 patients (7.5%), and Reg-Q in 26 patients (16.4%). Age, gender and BMI were no different between the groups. Regression was more likely in patients infected with genotype 2 (p=0.047); 3 of 7 patients infected with genotype 2 regressed, 2 of whom had achieved SVR. Regression was observed in 9 of 18 patients (50%) who had achieved SVR but also in 29 of 141 (21%) patients despite persistent viremia (p=0.003). Amongst this limited cohort of persistently viremic individuals, there were no significant predictors of fibrosis regression.
Conclusions: Hepatic fibrosis regression is more likely in patients infected with genotype 2 CHC and in those who have achieved SVR, however hepatic fibrosis regression may also occur in up to 21% of patients in the presence of persistent viremia; further study is required to identify factors predicting regression in this subgroup.
Category: Liver & Pancreas
Monday, March 22, 2010 1:00 PM
Poster Session II # 185, Monday Afternoon