Long‐term follow‐up of the hepatitis C HENCORE cohort: response to therapy and occurrence of liver‐related complications

Abstract

Summary. The aims of the study were to verify the long‐term effect of time on viral clearance in hepatitis C virus (HCV) patients and to find out factors possibly associated with disease progression. A total of 1641 patients recruited from eight European centres in 1996–1997 were re‐analysed 5–7 years after inclusion. The occurrence of decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation was analysed in relation to different host and viral factors. Ninety‐three per cent of the HCV patients who had cleared the virus (spontaneously or after antiviral therapy) remained HCV‐RNA‐negative during follow up and may be considered as ‘cured’. Among patients who were sustained responders at inclusion, 2.3% developed liver complications during follow up, and 31% of non‐responders did. Advanced age at infection and presence of the human leucocyte antigen (HLA) DRB1*1201–3 allele were possibly associated with a higher rate of progression to decompensated cirrhosis or HCC. Decompensated cirrhosis might be further associated with male gender, non‐response to previous therapy, and lack of HLA DRB1*1301 allele, whereas HCC seems to be associated with the presence of the HLA DQ02 allele. Long‐term follow up of HCV patients indicates that virological response persists over time and is associated with a very low incidence of liver complications. Advanced age at inclusion, advanced age at infection, viral genotype 1, non‐response to previous therapy and possibly some specific HLA alleles are factors independently associated with a faster rate of progression towards liver complications. The large proportion of patients lost to follow up stresses the need for a strengthened and optimized management of HCV patients.