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SVR after HCV treatment improves liver stiffness in progressive fibrosis

Sustained virologic response after direct-acting antiviral treatment for hepatitis C significantly improved liver stiffness from baseline to end of treatment, and continued to improve liver stiffness among those with progressive fibrosis at 24 weeks posttreatment, according to recently published data.

“Chronic infection with hepatitis C virus (HCV) induces the progression of liver fibrosis, which results in the development of cirrhosis and hepatocellular carcinoma (HCC),” Toshifumi Tada, MD, from the Ogaki Municipal Hospital, and colleagues wrote. “Liver stiffness is influenced not only by the degree of liver fibrosis but also by necroinflammatory activity.”

The study comprised 210 patients who achieved SVR with daclatasvir and asunaprevir between September 2014 and August 2016. The researchers used fibrosis-4 index and aspartate aminotransferase-to-platelet ratio index (APRI) to assess the degree of liver fibrosis and shear wave elastography to measure liver stiffness.

Median patient age was 71.5 years (range, 66-77 years) and 114 were women. Median FIB-4 index was 3.36 (range, 2.3-4.84) and median liver stiffness was 10.2 kPa (range, 7.7-14.7 kPa).

From baseline to end of treatment, investigators observed significant improvements in alanine aminotransferase (32 vs. 17 IU/L; P < .001), AST (40 vs. 25 IU/L; P < .001), albumin (4.2 vs. 4.3; g/dL; P < .001), total bilirubin (0.6 vs. 0.7 mg/dL; P < .001), alpha-fetoprotein (0.63 vs. 0.42 log ng/mL; P < .001), FIB-4 index (3.36 vs. 2.81; P < .001), APRI (0.68 vs. 0.41; P < .001) and liver stiffness (10.2 vs. 8.8 kPa; P < .001).

Similarly, from end of treatment to 24 weeks of SVR, patients had significant improvements in ALT (14 IU/L; P < .001), AST (23 IU/L; P < .001), albumin (4.4 g/dL; P < .001), total bilirubin (0.7 mg/dL; P = .002), FIB-4 index (2.7; P = .036), APRI (0.36; P < .001) and liver stiffness (7.6 kPa; P < .001).

Between end of treatment and SVR, platelet count also improved significantly (0.42 vs. 04 x 10⁴/mm³; P < .001).

Patients with ALT levels of 30 IU/L or less and FIB-4 index of 2 or less had significant improvement in liver stiffness from baseline to end of treatment (7 vs. 6.7 kPa; P = .047). Among patients with ALT levels of 30 IU/L or less and FIB-4 index higher than 2 (n = 75), liver stiffness decreased significantly from both baseline to end of treatment (9.6 vs. 9.2 kPa; P < .001) and from end of treatment to 24 weeks of SVR (7.7 kPa; P < .001).

“These results suggest that early improvement of liver stiffness starts during the administration of DAAs in patients who achieve SVR, and this effect is particularly pronounced in patients with progressive liver fibrosis,” the researchers concluded. “Further studies should examine the association between liver stiffness improvement and risk reduction of decompensated cirrhosis, HCC, and death in chronic HCV patients who receive DAA therapy and achieve SVR.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.