Page 35 - The Flying Publisher Guide to Hepatitis C Treatment

Patients’ monitoring during and after treatment | 35

comparator for mutations emerging at later time points, during
or after treatment. On-treatment viremic samples are analyzed
to determine specific changes associated with decreased
susceptibility and virologic failure. Post-treatment samples are
analyzed for persistence or loss of resistant variants and may
help distinguish between re-infection and relapse. More details
on the impact of resistance on HCV treatment are given in
chapter 4.

Assessment of hepatic fibrosis

CHC may progress to cirrhosis (in approximately 20% of patients,
with a mean duration of 20 years) and subsequently,
decompensation and complications, including HCC, develop in
about 30% of cases over a period of approximately 4 years
(DiBisceglie 2008). Histologically significant liver disease can be
also present in patients without symptoms and with normal ALT
levels. In theses cases, deferring treatment until liver function is
depressed (low albumin, altered PT) may decrease SVR rate and
increase the risk of AEs (Pradat 2002). Evaluation of liver fibrosis
is thus compulsory (Table 2.3).

Liver biopsy
Liver biopsy (LB) is the gold standard for (i) liver disease staging,
(ii) treatment decisions and (iii) prognostication, as it may reveal
advanced fibrosis or cirrhosis that necessitates surveillance for
HCC and/or screening for varices.
Before treatment LB is indicated for prognostic purposes and
guiding treatment decisions. If LB shows significant fibrosis
treatment should be initiated, otherwise, treatment can be
deferred (Afdhal 2009). Individualized treatment decisions are
based on the severity of liver disease. Treatment is indicated in
patients with compensated cirrhosis provided they do not have
contraindications to therapy.