HALT-C: Quantitative liver function tests confirm
improvement after SVR in HCV-infected patients
By Dorothy J. Schirf, MD
November 15, 2005
Sustained virologic response (SVR) is
linked to improvements in hepatic function, according to a
report from the Hepatitis C Antiviral Long-term Treatment
(HALT-C) trial investigators. This analysis also demonstrated
that quantitative liver function tests are better able to
detect these improvements when compared with traditional
laboratory evaluation.
In the initial phase of the HALT-C study,
patients received 24 weeks of treatment with peginterferon
alfa-2a plus ribavirin. Following determination of HCV RNA at
Week 20, treatment for nonresponders was extended to 48 weeks.
Subjects who had repeat measures of quantitative liver
function before and following SVR were included in the
analysis.
The participants had a mean age of 49 years
and were predominantly male, and they had a mean HCV RNA level
of 6.45 log10 copies/mL at baseline. Nearly
one quarter of the individuals were cirrhotic, and 76% were
infected with HCV genotype 1.
By design, quantitative liver function
tests were used to provide an assessment of hepatic metabolism
and the liver’s capacity to process test compounds. Among
other markers, saliva concentrations of caffeine and
antipyrine and serum concentration of cholate were analyzed.
Functional constants, such as elimination rate, volume of
distribution, clearance, and shunt fraction, were also
assessed. Hepatic perfusion was evaluated by computed
tomography. The quantitative test panel was run on all 21
available candidates, with a mean time between testing of 30.2
months.
Results demonstrated improvements in the
clearance of chemicals relying on hepatic metabolism following
SVR. Similarly, portal blood flow improved, based on decreased
cholate shunt and oral cholate clearance. The investigators
concluded these noninvasive markers will provide a useful tool
in assessing treatment efficacy and hepatic changes for both
cirrhotic and noncirrhotic individuals with chronic hepatitis
B.
Reference
Everson GT, Shiffman ML, Hoefs JC, et al. Hepatic function
improves after sustained virologic response in hepatitis C
patients with advanced fibrosis and cirrhosis: results of the
lead-in phase of the HALT-C trial. Program and abstracts of
the 56th Annual Meeting of the American Association for the
Study of Liver Diseases; November 11-15, 2005; San Francisco,
California. Abstract 1265.