HEPATITIS C virus (HCV) can be effectively cured in nearly all cases with medication and current estimations predict around 750,000 patients to be cured annually, until 2030. However, if significant liver damage is present at the time of cure, there remains a risk of liver cancer and complications related to portal hypertension, such as abdominal fluid accumulation, bleeding in the digestive tract, and confusion. Findings from recent studies led by Georg Semmler, Medical University of Vienna, Austria, have suggested that liver stiffness should be the primary indicator to assess risk of after HCV treatment.
One of the two recent studies retrospectively analysed a cohort of 2,335 patients from various European countries whose HCV was cured in advanced but asymptomatic stages using interferon–free therapies. Their compensated advanced chronic liver disease was indicated by a liver stiffness measurement of 10 kPa or higher. The median age of the cohort was 60.2 years (±11.9 years), with 21.1% being obese and 21.2% having diabetes. Over a median follow-up period of six years, first hepatic decompensation occurred in 84 patients (3.6%) and 183 patients (7.8%) developed de novo hepatocellular carcinoma (HCC) with both risks increasing linearly over time.
The Baveno VII criteria developed by the researchers were effective in stratifying the risk of hepatic decompensation. Patients with a follow-up liver stiffness measurement of less than 12 kPa and a platelet count greater than 150 g/L were excluded from clinically significant portal hypertension (CSPH), while those with a liver stiffness measurement of 25 kPa or higher were ruled in. These criteria provided proportional hazard estimates for the risk of hepatic decompensation. For patients who did not meet either criterion, the estimated probability of CSPH helped distinguish between those who would develop hepatic decompensation and those who would not.
The long-term study has validated the criteria which are now recommended by the European Liver Association. These findings contribute significantly to determining individual risk and enabling personalised follow-up care as patients with compensated advanced chronic liver disease face constant risks of hepatic decompensation and HCC even in the long term, beyond three years after HCV cure.
Katie Wright, EMJ
Reference
Semmler G et al. Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure. Hepatology. 2024;DOI:10.1097/HEP.0000000000001005.
