Radera Shruti, Rungta Sumit, Jeet Amar, Jain Amita
Microbiology, King George's Medical University, Lucknow, IND.
Gastroenterology, King George's Medical University, Lucknow, IND.
Cureus. 2025 Feb 27;17(2):e79766. doi: 10.7759/cureus.79766. eCollection 2025 Feb.
Introduction Hepatitis C is a significant global health concern, causing many deaths. In the National Viral Hepatitis Control Program (NVHCP), direct-acting antiviral (DAA) therapy (sofosbuvir and velpatasvir, without ribavirin) is used to achieve sustained virological response (SVR) in hepatitis C virus (HCV)-infected individuals. The duration is longer for decompensated liver cirrhosis disease (DCLD) patients (24 weeks) compared to compensated liver cirrhosis disease (CLD) patients (12 weeks). The present study was planned to assess SVR in patients with HCV infection, both with CLD and DCLD, at 12 weeks, 6 months, and 1 year after treatment initiation. Methods This pilot study enrolled 100 treatment-naïve chronic hepatitis C patients, with 50 having CLD and 50 having DCLD. Serum samples were collected from these patients before treatment initiation, and follow-up samples were collected at 12 weeks, 6 months, and 1 year after initiation of treatment to monitor SVR in both groups by real-time polymerase chain reaction (PCR). Results Among 50 DCLD patients, three died within the first three months of treatment. The remaining 47 achieved an undetectable viral load at 12 weeks (100%). By six months, two more patients had died, and one experienced viral relapse, resulting in a 97.9% SVR. However, by one year, all surviving patients had no detectable viral load. The DCLD group had a 10% mortality rate (5/50), including three deaths within 12 weeks (one from variceal bleeding and two from non-liver-related causes), and two post-treatment despite achieving SVR. Mortality was not linked to viral load, suggesting that liver function and disease severity play a more significant role in patient outcomes. All CLD patients achieved SVR at 12 weeks after initiation of therapy (100%), which persisted at six months and one-year follow-up. Conclusion DAA therapy is highly effective, achieving a 100% SVR rate and sustained liver function improvement in HCV-infected patients with liver disease.
引言
丙型肝炎是一个重大的全球健康问题，导致许多人死亡。在国家病毒性肝炎控制项目（NVHCP）中，直接抗病毒（DAA）疗法（索磷布韦和维帕他韦，不含利巴韦林）用于使丙型肝炎病毒（HCV）感染个体实现持续病毒学应答（SVR）。与代偿期肝硬化疾病（CLD）患者（12周）相比，失代偿期肝硬化疾病（DCLD）患者的治疗持续时间更长（24周）。本研究旨在评估HCV感染患者（包括CLD和DCLD患者）在治疗开始后12周、6个月和1年时的SVR情况。
方法
这项初步研究纳入了100例初治慢性丙型肝炎患者，其中50例为CLD患者，50例为DCLD患者。在治疗开始前采集这些患者的血清样本，并在治疗开始后12周、6个月和1年采集随访样本，通过实时聚合酶链反应（PCR）监测两组患者的SVR情况。
结果
在50例DCLD患者中，3例在治疗的前三个月内死亡。其余47例在12周时病毒载量检测不到（100%）。到6个月时，又有2例患者死亡，1例出现病毒复发，SVR率为97.9%。然而，到1年时，所有存活患者的病毒载量均检测不到。DCLD组的死亡率为10%（5/50），包括12周内的3例死亡（1例死于静脉曲张出血，2例死于非肝脏相关原因），以及2例在实现SVR后治疗期间死亡。死亡率与病毒载量无关，这表明肝功能和疾病严重程度在患者预后中起更重要的作用。所有CLD患者在治疗开始后12周时实现了SVR（100%），在6个月和1年的随访中持续保持。
结论
DAA疗法非常有效，在患有肝病的HCV感染患者中实现了100%的SVR率，并持续改善肝功能。
