1. Impact of direct acting antiviral drugs in treatment naïve HCV cirrhosis on fibrosis and severity of liver disease: a real life experience from a tertiary care center of North India

Abstract

Background and Aims: Treatment of chronic hepatitis C infection with direct-acting antiviral (DAA) drugs has been highly effective, but data regarding benefit in advanced liver disease is relatively scarce in Indian patients. The aim of this study was to determine the effects of DAA in patients with HCV related cirrhosis (compensated/decompensated) that achieved sustained virological response post therapy at 12 weeks (SVR12). Methods: 63 patients with HCV related cirrhosis treated with Sofosbuvir based regimen were evaluated. The primary end point was to evaluate the effect of treatment (SVR12) on the severity of liver disease with the secondary end point being to observe for any adverse events related to treatment. Results: Treatment naïve patients with HCV cirrhosis either due to genotype 1 or genotype 3 were divided into two groups: group A (compensated cirrhosis), group B (decompensated cirrhosis). SVR12 in group A was 91.66% (33/37) and in group, B was 73.17% (30/41). Baseline mean liver stiffness measurement (LSM) in group A was 16.81 ± 3.57 kPa which decreased to 11.19 ± 1.75 kPa at SVR12 (p-value < 0.0001). Baseline mean APRI and FIB-4 Score in group A were 1.228 ± 0.499 & 2.61 ± 1.06 and in group B were 2.156 ± 1.10 & 5.71 ± 2.06 respectively which decrease to 0.415 ± 0.115 & 1.25 ± 0.46 in group A, to 0.759 ± 0.275 & 2.60 ± 1.12 in group B following SVR12 (p value < .0001). Mean MELD-Na improved from baseline 9.93 ± 2.04, 20.70 ± 4.52 to 7.21 ± 0.92, 14.23 ± 4.51 respectively in group A and B at SVR12 (p-value < .0001). CTP Score improved by 1 in 27.27% (9/33) and ≥2 in 76.67% (23/30) of patients in group A and group B respectively. Conclusions: There was a significant improvement in severity of liver disease as depicted by the decrease in LSM and other noninvasive marker of fibrosis in patients who achieved SVR12 on DAA therapy. The authors have none to declare.