All people with chronic hepatitis C virus (HCV) infection should start therapy with direct-acting antivirals, research published in the online edition of Clinical Infectious Diseases suggests. Investigators from the United States found that individuals with moderate fibrosis had an increased risk of mortality, and that there was no accurate way of predicting disease progression of fibrosis from mild to moderate.
The study followed 964 people with HCV for a median of 5.9 years after a first measurement of liver stiffness. The study found that people with moderate fibrosis (liver stiffness score between 8 and 12.3) were 42% more likely to die than people with mild or no fibrosis during the follow-up period. For every hundred people with moderate fibrosis, 3.5 died for each year of follow up, compared to 2.2 of those with mild or no fibrosis.
The study found that although changes in liver stiffness measurement predicted who would subsequently progress from mild to moderate fibrosis, 28% of people who would progress from mild to moderate fibrosis would be missed if annual changes in liver stiffness measurement were used to predict progression. Insurance company restrictions that withhold treatment for people with mild fibrosis are unsound, the authors conclude, because it is not possible to predict with sufficient accuracy who will progress to moderate fibrosis and hence to an increased risk of death.
The study authors say that their findings support current US guidelines developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), which recommend treatment for everyone with hepatitis C including those with mild fibrosis.
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