Rincon D et al. (2006) Antiviral therapy decreases hepatic venous pressure gradient in patients with chronic hepatitis C and advanced fibrosis. Am J Gastroenterol 101: 2269–2274

Portal hypertension is a common and lethal complication of chronic hepatitis C (CHC)-related cirrhosis. Antiviral therapy has beneficial effects on liver histology in patients with CHC, but its effect on portal hypertension is unknown.

Rincon and colleagues treated 20 patients with CHC, advanced fibrosis or compensated cirrhosis, and portal hypertension (i.e. a hepatic venous pressure gradient [HVPG] >5 mmHg). Patients were treated with pegylated interferon α2b plus ribavirin for 24 or 48 weeks, depending on HCV genotype. At the end of treatment, mean HVPG decreased, from 13.8 mmHg to 10.2 mmHg, in all but one patient. The drop in HVPG was greatest in patients who achieved a virologic or biochemical response by the end of therapy, and in those whose METAVIR necrosis and inflammation score improved by ≥2 points. Of 11 patients with clinically significant portal hypertension (baseline HVPG ≥12 mmHg), 9 achieved the current goals of pharmacologic treatment of portal hypertension: 3 showed a >20% reduction in HVPG and a further 6 achieved a final HVPG of <12 mmHg. Achievement of either therapeutic target is associated with a markedly improved prognosis.

The authors conclude that, in patients with compensated CHC and advanced fibrosis or cirrhosis, antiviral therapy markedly decreases portal pressure, even when clinically significant portal hypertension is present. They suggest that the efficacy of antiviral therapy might be related to a reduction in hepatic inflammation.