Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection

P>Background Most studies evaluating chronic hepatitis C virus (HCV) natural history have taken the development of cirrhosis as an end-point. Aim To perform a systematic review of the literature to establish the outcome of compensated HCV cirrhosis. Methods A systematic literature review was performed. Only data regarding HCV mono-infected patients were included. Weighted mean annual percentage rates for death/transplantation, decompensation of cirrhosis and development of HCC were calculated. Results Thirteen papers were included. Despite some heterogeneity, we extracted data relating to 2386 patients. In compensated HCV cirrhosis, the estimated annual rate of death/transplantation is 4.58%, that of decompensation is 6.37% per and that of HCC, 3.36%. When compared with studies of untreated patients, studies that included treated patients reported significantly lower mean annual percentage rates of HCC (2.52% vs. 4.79%, P = 0.02), but not decompensation (5.34% vs. 7.88%, P = 0.026) and death/transplantation (3.79% vs. 4.62%, P = 0.25). Conclusions These rates highlight the need for continued vigilance for the occurrence of HCC, while confirming the relatively slow progress of compensated HCV cirrhosis. Heterogeneity in reporting means that these data may underestimate the rate of disease progression, particularly HCC development. It will be important to ensure clearer distinction between treatment responses in future studies.