Long-term surveillance of liver histological changes in chronic hepatitis C patients completing pegylated interferon-alpha plus ribavirin therapy: an observational cohort study

Background: For chronic hepatitis C (CHC) patients completing pegylated interferon (PegIFN)-alpha/ribavirin therapy, long-term liver histological changes remain largely unexplored. Methods: This observational cohort study included 85 CHC patients completing PegIFN-alpha/ribavirin therapy with liver biopsies performed at baseline and the end of surveillance (EOS). Median years between paired biopsies were 6.75 (interquartile range: 5.63-7.54). Results: In patients with baseline METAVIR fibrosis stages (F) <4 (able to undergo fibrosis progression; n=77), cases achieving sustained virological response (SVR) (n=52) had a significantly lower rate of fibrosis progression than non-SVR cases (n=25) (3.8% versus 24.0%, p= 0.012). Among the entire cohort (n=85), the rate of activity response [METAVIR activity grades (A) decreasing or maintaining at A0] in SVR cases (n=59) was significantly higher than that in non-SVR cases (n=26) (94.9% versus 65.4%, p=0.001). For SVR cases among the entire cohort, independent predictors of fibrosis clearance included baseline F <2 [odds ratio (OR)=7.877, p=0.042] and aspartate transaminase (AST) levels declining by >70% at EOS compared with baseline (OR=9.013, p= 0.038). For non-SVR cases among the entire cohort, baseline AST levels >80 U/l and glucose levels <= 105 mg/dl independently predicted significant fibrosis (F2/F3/F4) at EOS (OR=12.558, p= 0.049) and activity response (OR =17.741, p=0.047), respectively. Conclusions: Among CHC patients completing PegIFN-alpha/ribavirin therapy, SVR lowers the risk of liver histological progression but does not guarantee fibrosis clearance. For SVR cases, those with baseline F >= 2 or without significantly declined follow-up AST levels should be specifically monitored. As for non-SVR cases, those with a higher baseline AST or glucose level should preferentially receive retreatment.