Severity of Liver Disease Affects HCV Kinetics in Patients Treated with Intravenous Silibinin Monotherapy

Abstract

Background

HCV kinetic analysis and modelling during antiviral therapy have not been performed in decompensated cirrhotic patients awaiting liver transplantation. Here, viral and host parameters were compared in three groups of patients treated with daily intravenous silibinin (SIL) monotherapy for 7 days according to the severity of their liver disease.

Methods

Data were obtained from 25 patients, 12 non-cirrhotic, 8 with compensated cirrhosis and 5 with decompensated cirrhosis. The standard-biphasic model with time-varying SIL effectiveness (from 0 to final effectiveness [ε_max]) was fitted to viral kinetic data.

Results

Baseline viral load and age were significantly associated with the severity of liver disease (P<0.0001). A biphasic viral decline was observed in most patients with a higher first phase decline in patients with less severe liver disease. The ε_max was significantly (P≤0.032) associated with increasing severity of liver disease (non-cirrhotic ε_max [se]=0.86 [0.05], compensated cirrhotic ε_max=0.69 [0.06] and decompensated cirrhotic ε_max=0.59 [0.1]). The second phase decline slope was not significantly different among groups (mean 1.88 ±0.15 log₁₀ IU/ml/week, P=0.75) as was the rate of change of SIL effectiveness (k=2.12/day [se=0.18/day]). HCV-infected cell loss rate (δ [se]=0.62/ day [0.05/day]) was high and similar among groups.

Conclusions

The high loss rate of HCV-infected cells suggests that sufficient dose and duration of SIL might achieve viral suppression in advanced liver disease.