End-stage liver disease from hepatitis C is a leading cause of decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related deaths. The goals of antiviral therapy are to prevent these sequelae and prolong life. Clinical trials of ?-interferons and ribavirin have used sustained viral response as an outcome because it is considered synonymous with cure and is assumed to be associated with decreasing complications caused by cirrhosis. However, it is only recently that data has emerged supporting this assumption.
This study demonstrates that meaningful clinical end points are seen in patients who achieve a sustained virologic response (SVR) with a reduction in liver-related deaths, rates of hepatocellular carcinoma (HCC) and liver-related complications. None of the patients who achieved SVR developed variceal bleeding.
The rates of HCC were significantly lower in the SVR group, but six cases of HCC occurred in the SVR group, underscoring the importance of continued surveillance in hepatitis C virus patients with SVR who have advanced fibrosis or cirrhosis.