Author information

¹Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.

²Chairman, Technical Resource Group - National Viral Hepatitis Control Program (NVHCP), Government of India, India; Director, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India. Electronic address: rkpsdhiman@hotmail.com.

³Department of Hepatology, Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India.

⁴Department of Virology, Institute of Liver and Biliary Sciences (ILBS), New Delhi.

⁵Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.

⁶Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.

⁷Program Officer, Hepatitis C Virus Infection, Government of Punjab, India.

⁸Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

Background and aims: Chronic hepatitis C(CHC) related decompensated cirrhosis is associated with lower SVR-12 rates and variable regression of disease severity following direct-acting antiviral agents (DAAs). We assessed rates of SVR-12, recompensation (Baveno VII criteria), and survival in such patients.

Methods: Between July 2018-July 2023, patients with decompensated CHC-related cirrhosis post DAAs treatment, were evaluated for SVR-12 and then had 6-monthly follow-up.

Results: Of 6516 patients with cirrhosis, 1152 with decompensated cirrhosis (age 53.2±11.5 years,63% men, MELD-Na:16.5± 4.6,87% genotype 3) were enrolled. SVR-12 was 81.8% after one course; ultimately SVR was 90.8% following additional treatment. Decompensation events included ascites (1098,95.3%), hepatic encephalopathy (191,16.6%), and variceal bleeding (284,24.7%). Ascites resolved in 86% (diuretic withdrawal achieved in 24% patients). Recompensation occurred in 284(24.7%) at a median time of 16.5(IQR-14.5-20.5) months. On multivariable Cox proportional hazards analysis, low bilirubin(aHR-0.6,95%CI-0.5-0.8,P<0.001), INR(aHR-0.2,95%CI:0.1-0.3,P<0.001), absence of large esophageal varices(aHR-0.4,95%CI:0.2-0.9,P=0.048), or gastric varices (aHR-0.5,95%CI:0.3-0.7,P=0.022) predicted recompensation. Portal hypertension (PHT) progressed in 158(13.7%) patients, with rebleed in 4%. Prior decompensation with variceal bleeding (aHR-1.6,95%CI:1.2-2.8, P=0.042), and presence of large varices (aHR-2.9,95%CI:1.3-6.5,P<0.001) were associated with PHT progression. Further decompensation was seen in 221(19%);145 patients died and 6 underwent liver transplant. A decrease in MELDNa of ≥3 was in 409(35.5%) and a final MELDNa score of <10 was in 335(29%), but 2.9% developed HCC despite SVR-12.

Conclusions: SVR-12 in HCV-related decompensated cirrhosis in a predominant genotype 3 population, led to recompensation in 24.7% of patients over a follow-up of 4 years in a public health setting. Despite SVR-12, new hepatic decompensation evolved in 19% and HCC developed in 2.9% of patients.