Background: The aim of this study was to determine whether the pretreatment laparoscopic appearance of the liver is an additional predictor of response to combination therapy with interferon and ribavirin in patients with hepatitis C.
Methods: A retrospective review was performed of 112 patients (61 men, 51 women [ratio 1.3:1]; mean age 50 [10] years, range 15-73 years) with untreated hepatitis C, without other causes of liver disease, who underwent diagnostic laparoscopy before combination therapy with interferon and ribavirin for at least 24 weeks with a 24-week post-treatment follow-up. Fifty-nine were white, 37 Hispanic, and 16 African American. Patients were divided into responders and non-responders based on viral clearance. Demographics, genotype, pre-therapy hepatitis C virus RNA, histopathologic, and laparoscopic appearances were analyzed.
Results: Ninety-three patients (83%) had genotype 1 with a mean pretreatment hepatitis C virus RNA of 3.2 (2.8) million copies/mL. Thirty-seven (33%) had laparoscopic evidence of cirrhosis, whereas, only 30 (26.4%) had cirrhosis by histopathologic criteria. Patients were treated with interferon and ribavirin (mean dose 10.6 [2.5] mg/kg) for a mean duration of 37.7 (11.4) weeks, depending on response and genotype. A sustained response was observed in 26 (23%) patients; in 12 (11%), there was only a biochemical response (biochemical responder), while 59 (53%) and 15 (13%) were classified, respectively, as non-responders and relapsers. Logistic regression analysis revealed that pretreatment laparoscopic appearance (p = 0.034) and genotype (p = 0.002) were significant predictive factors; that is, a lesser extent of fibrosis at laparoscopy and genotypes other than 1 were predictive of a sustained response to combination therapy.
Conclusions: Pretreatment laparoscopic appearance alone and genotype are significant predictors of a sustained response to combination therapy in patients with hepatitis C. Laparoscopy and biopsy are complementary for the diagnosis of cirrhosis in hepatitis C.