Fibrosis progression in chronic hepatitis C: Morphometric image analysis in the HALT‐C trial

Computer‐assisted morphometry can provide precise measurement of hepatic fibrosis on a continuous scale. Previous morphometric studies of large cohorts of patients with treatment refractory chronic hepatitis C have shown a mean increase in fibrosis of 30% to 58% in 1 year. The aim of the present stu...

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Published in:Hepatology (Baltimore, Md.) Md.), 2009-12, Vol.50 (6), p.1738-1749
Main Authors: Goodman, Zachary D., Stoddard, Anne M., Bonkovsky, Herbert L., Fontana, Robert J., Ghany, Marc G., Morgan, Timothy R., Wright, Elizabeth C., Brunt, Elizabeth M., Kleiner, David E., Shiffman, Mitchell L., Everson, Gregory T., Lindsay, Karen L., Dienstag, Jules L., Morishima, Chihiro
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Collagen - analysis
Disease Progression
Female
Gastroenterology. Liver. Pancreas. Abdomen
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - metabolism
Hepatitis C, Chronic - pathology
Human viral diseases
Humans
Infectious diseases
Liver - pathology
Liver Cirrhosis - pathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Viral diseases
Viral hepatitis
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Summary:Computer‐assisted morphometry can provide precise measurement of hepatic fibrosis on a continuous scale. Previous morphometric studies of large cohorts of patients with treatment refractory chronic hepatitis C have shown a mean increase in fibrosis of 30% to 58% in 1 year. The aim of the present study was to quantify fibrosis progression in biopsy specimens obtained over 1.5 to 5 years from three groups of patients with baseline bridging fibrosis or cirrhosis (Ishak stages 3‐6) enrolled in the Hepatitis C Antiviral Long‐term Treatment Against Cirrhosis Trial. The main group of 346 lead‐in nonresponders (viremic after 24 weeks of peginterferon‐ribavirin therapy) had a mean fibrosis increase of 61% over pretreatment baseline after 2 years and 80% after 4 years. In contrast, the 78 breakthrough/relapse patients (undetectable serum hepatitis C virus RNA after 24 weeks of peginterferon‐ribavirin and receiving antiviral therapy for 48 weeks) showed a mean increase in fibrosis of 48% when biopsied 36 months from pretreatment baseline but no further increase at 60 months. Finally, the 111 express patients with baseline biopsies following unsuccessful peginterferon‐ribavirin outside the trial had significantly more baseline fibrosis than the others but an increase of only 21% after 21 months and a slight decrease at 45 months. Maintenance therapy with low‐dose peginterferon had no effect on fibrosis changes in any of the groups. Conclusion: Morphometry demonstrated complex, nonlinear changes in fibrosis over time in this heterogeneous cohort of patients with interferon‐refractory chronic hepatitis C. (HEPATOLOGY 2009.)
ISSN:0270-9139
1527-3350
DOI:10.1002/hep.23211