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Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection
W Alazawi1, M Cunningham, J Dearden
1Queen Mary University of London, Blizard Institute of Cellular and Molecular Science, London, UK.
Insights
This systematic review found that compensated hepatitis C virus (HCV) cirrhosis has a slow progression. However, vigilance for hepatocellular carcinoma (HCC) is crucial, as treatment may reduce HCC rates.
Area of Science:
- Hepatology
- Viral Hepatitis Research
- Clinical Outcomes
Background:
- Chronic hepatitis C virus (HCV) infection often leads to cirrhosis.
- Previous studies focused on cirrhosis development as the primary outcome.
- The natural history and outcomes of compensated HCV cirrhosis require further elucidation.
Purpose of the Study:
- To systematically review the literature on the outcomes of compensated hepatitis C virus cirrhosis.
- To establish the annual rates of death/transplantation, decompensation, and hepatocellular carcinoma (HCC) in this patient group.
Main Methods:
- A systematic literature review was conducted.
- Data from HCV mono-infected patients were exclusively included.
- Weighted mean annual percentage rates for key adverse events were calculated.
Main Results:
- Thirteen studies comprising 2386 patients were analyzed.
- The estimated annual rates for compensated HCV cirrhosis were: death/transplantation (4.58%), decompensation (6.37%), and HCC (3.36%).
- Treated patients showed significantly lower HCC rates compared to untreated patients (2.52% vs. 4.79%).
Conclusions:
- Compensated HCV cirrhosis progresses relatively slowly, but ongoing monitoring for HCC is essential.
- Data heterogeneity may lead to underestimation of disease progression, particularly HCC development.
- Future studies need clearer reporting on treatment responses to better distinguish outcomes.
Background:
Most studies evaluating chronic hepatitis C virus (HCV) natural history have taken the development of cirrhosis as an end-point.
Aim:
To perform a systematic review of the literature to establish the outcome of compensated HCV cirrhosis.
Methods:
A systematic literature review was performed. Only data regarding HCV mono-infected patients were included. Weighted mean annual percentage rates for death/transplantation, decompensation of cirrhosis and development of HCC were calculated.
Results:
Thirteen papers were included. Despite some heterogeneity, we extracted data relating to 2386 patients. In compensated HCV cirrhosis, the estimated annual rate of death/transplantation is 4.58%, that of decompensation is 6.37% per and that of HCC, 3.36%. When compared with studies of untreated patients, studies that included treated patients reported significantly lower mean annual percentage rates of HCC (2.52% vs. 4.79%, P = 0.02), but not decompensation (5.34% vs. 7.88%, P = 0.026) and death/transplantation (3.79% vs. 4.62%, P = 0.25).
Conclusions:
These rates highlight the need for continued vigilance for the occurrence of HCC, while confirming the relatively slow progress of compensated HCV cirrhosis. Heterogeneity in reporting means that these data may underestimate the rate of disease progression, particularly HCC development. It will be important to ensure clearer distinction between treatment responses in future studies.
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