New interferon-free treatments for patients with hepatitis C were shown to decrease hypertension of the portal vein — which carries blood from the gut to the liver — decreasing the risk of liver-related complications. The study, “Sustained virologic response to interferon-free therapies ameliorates HCV-induced portal hypertension,” conducted by researchers at the Medical University of Vienna, Austria, was recently published in the Journal of Hepatology.
Chronic hepatitis C virus (HCV) infection is estimated to affect 3.5 million people in the U.S. alone. It attacks the liver and causes an inflammation that slowly induces scarring and permanent damage to the organ, known as cirrhosis. From 5 to 20 percent of people with HCV are thought to develop cirrhosis, which induces end-stage liver disease, liver failure, or even liver cancer.
Liver scarring can hamper the blood flow through the liver, which often leads to hypertension in the portal vein, which in turn can result in bleeding from varices in the stomach or esophagus, or in fluid build-up in the peritoneal cavity.
Until recently, hepatitis C was treated with injections of pegylated interferon (IFN) and ribavirin. Although these drugs were able to significantly reduce the portal pressure in some patients, the recovery rates in HCV patients were poor and accompanied by substantial rates of serious adverse effects that greatly limited the use of IFN-based therapies.
More recently, IFN-free therapies have been shown to be highly effective and generally well tolerated, improving liver function, increasing platelet numbers, and possibly decreasing liver stiffness, which pointed to a decrease in portal hypertension. Therefore, the researchers aimed at understanding whether IFN-free therapies were able to impact portal hypertension.
The research group, headed by Peter Ferenci, Harald Hofer, and Markus Peck-Radosavljevic of the Department of Gastroenterology and Hepatology at the Medical University of Vienna, retrospectively examined patients who were treated with IFN-free therapies and who underwent portal vein pressure measurements.
The results showed that HCV eradication decreased portal pressure, but this decrease was less common in patients with advanced liver dysfunction, suggesting that portal vein hypertension is more likely to be controlled in patients treated at an early stage of the disease.
“As a general rule, the probability of portal vein hypertension diminishing is greater the earlier treatment was started,” said Mattias Mandorfer, the study’s first author, in a press release. “However, despite the promising results, we still strongly recommend that patients attend check-ups, because portal vein hypertension does not diminish in all patients, and, irrespective of whether it does or does not, there is a risk of developing liver cancer as a result of cirrhosis.”