Long-term Clinical Outcome of Treatment for Chronic Hepatitis C

Worldwide, 170 million people are chronically infected with the hepatitis C virus. The infection leads to inflammation and fibrosis of the liver and may eventually lead to liver failure or development of hepatocellular carcinoma. It is known that treatment with pegylated interferon and ribavirin may lead to sustained suppression of the hepatitis C virus. The aim of this thesis is to investigate whether patients with a sustained virological response have a prolonged life expectancy and whether they have a decreased risk of developing liver failure and hepatocellular carcinoma. In a first study we compared the survival of chronic hepatitis C patients from different European centers with the general population. Patients with a sustained virological response had a life expectancy similar to the general population, matched for age and gender. We also investigated patients with advanced liver fibrosis. In this study, data were collected from more than 500 European and Canadian patients. Among sustained virological responders there was a spectaculair decrease in the risk of developing liver failure and the 5-year risk of dying from a liver-related cause had decreased from 12.9 to 4.4 percent, compared to non-responders. Finally, the course of the disease in treated patients with advanced fibrosis was compared to the natural history, as predicted by a mathematical model. This comparison also suggested an improved outcome for patients who had undergone treatment with peginterferon and ribavirin. For this work, B.J. Veldt received a stipend from the Netherlands organisation for health research and development.