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Real-world clinical outcomes among individuals with chronic HCV infection in China: CCgenos study
Huiying Rao1, Qing Xie2, Jia Shang3
1Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Peking University People's Hospital, Beijing, China.
Insights
Treatment for chronic hepatitis C virus (HCV) infection significantly reduces disease progression. Achieving sustained virological response (SVR24) lowers overall progression risk but does not impact cirrhosis or hepatocellular carcinoma rates long-term.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Chronic hepatitis C virus (HCV) infection poses a significant global health burden.
- Understanding long-term outcomes in diverse patient populations is crucial for effective management.
- The CCgenos study provides longitudinal data on HCV progression in Han Chinese patients.
Purpose of the Study:
- To evaluate real-world outcomes in a cohort of 997 Han Chinese patients with chronic HCV infection over 5 years.
- To investigate the influence of HCV genotype, patient characteristics, and treatment status on disease progression.
- To identify risk factors associated with cirrhosis and hepatocellular carcinoma (HCC) development.
Main Methods:
- A 5-year follow-up of the CCgenos cross-sectional study.
- Collection of clinical data and HCV RNA levels.
- Definition of overall disease progression including cirrhosis, decompensated cirrhosis, HCC, liver transplant, or death.
- Application of Cox and logistic regression models to assess risk factors.
Main Results:
- Overall disease progression was significantly lower in treated (9.9%) versus untreated (23.6%) patients.
- Patients achieving sustained virological response at 24 weeks (SVR24) had lower overall disease progression (2.6%) compared to non-responders (13.4%).
- HCV genotype 1, older age, obesity, low platelet count, and elevated AST/APRI were associated with cirrhosis and HCC development.
Conclusions:
- Achieving SVR24 significantly reduces the probability of overall disease progression in chronic HCV patients.
- While SVR24 impacts overall progression, its effect on preventing cirrhosis and HCC within 5 years requires further investigation.
- Treatment and achieving viral suppression are key to mitigating long-term complications of HCV.
Background:
This 5-year follow-up of the CCgenos cross-sectional study aimed to observe real-life outcomes in a cohort of 997 Han Chinese patients with chronic HCV infection and to explore the impacts of HCV genotype, patient characteristics and treatment status.
Methods:
Clinical information and centralized HCV RNA measures were collected every 6/3 months for untreated/treated patients. Overall disease progression was defined as ≥1 of: de novo development of cirrhosis, Child-Turcotte-Pugh score increased by ≥2 points (if cirrhosis at baseline), progression to decompensated cirrhosis, hepatocellular carcinoma (HCC), liver transplant or death. Cox regression assessed risk factors for the time from estimated infection to cirrhosis or HCC. Logistic regression assessed risk factors for incidence rates of cirrhosis and overall disease progression.
Results:
281 of 514 patients enrolled across China completed 5 years of follow-up. Overall disease progression occurred in 36/364 (9.9%) treated patients and 35/148 (23.6%) untreated patients (odds ratio = 0.35; 95% CI 0.21, 0.59; P<0.0001). Overall disease progression occurred in 6/231 (2.6%) patients achieving sustained virological response at 24 weeks (SVR24) versus 11/82 (13.4%) who did not (P=0.0002). Cirrhosis development was significantly associated with abnormal aspartate aminotransferase (AST), age ≥40 years, body mass index ≥28 kg/m2, HCV GT1, platelet count <100×109/l, and AST to platelet ratio index (APRI) ≥2 (multivariate Cox regression, P<0.05). HCC was significantly associated with HCV GT1 and platelet count <100×109/l (multivariate Cox regression, P<0.05).
Conclusions:
Achieving SVR24 significantly reduced the probability of overall disease progression but no significant difference was seen for both cirrhosis and HCC during 5 years of follow-up.
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