Chronic Hepatitis C: Post-Cure Elastography Score Improvement

Abstract

Introduction: Elastography Scores are routinely obtained in the evaluation of chronic hepatitis C pts and help play a role in choosing proper DAA regimen. Follow up of Chronic Hepatitis C pts post-cure beyond 3 months is frequently undertaken, especially in pts with elevated elastography scores suggestive of significant fibrosis. Transient Elastography scores are known to be skewed by degree of ALT elevation. Alternative US elastography techniques such as Shear-Wave Elastography (SWE) with Supersonic Imagine Aixplorer device are not as widely utilized in US practice, but is used extensively elsewhere in the world. What affect cure of hepatitis C on elastography measurements one or more years post-cure and the clincial significance of a worsened or improved scores is not clear, as well as the role of additional co-factors that may drive liver fibrosis such as DM, HTN, obesity, smoking and excessive ETOH. Methods: Retrospective chart review of all Chronic Hepatitis C pts seen in our clinic over past 3 years in whom Hepatitis C virus was cured and fu for > 1 yr has occurred with both a pre-tx SWE score and subseqeunt post cure SWE score have been obtained. Clinical data examined included age, gender, BMI, presence of DM, HTN, smoking, and ETOH use. SWE was obtained uisng a XC6-L or SC6-L probe. Q box stability index minimum of 90% required for a vaild measuremen and 3 to 10 measurements obtained from right lobe liver. If right lobe SWE was unattainable, left lobe SWE was obtained. Univariate analysis of potential factors involved in SWE worsening or mprovement was with Fishers exact test. Results: 27 Hepatitis C pts met all inclusion criteria, 9 F:18 M. Genotype was 1a in 15, 1b in 5, 2 in 2 and 3 in five. BMI 29.8+6.8, HTN 15, DM 9, ETOH 7Smoking 11. Liver Bx was obtaiend in 16 pts, SWE scores ranged from 6.9 up to 66 with mean of 20.5 Post Hep C cure, SWE improved in 22 (81%), and worsened in 5 (19%). Improved SWE scores % change ranged from a low of 5.3% up to 85% with mean improvement of 32.6%. In the 5 pts in whom SWE score worsened, 2 had insignificant changes < 1% while the remaining worsened by 5.1%, 19.1% and 115%, respectively. No factor other than Hep C cure was found to play a role in SWE improvement. Conclusion: SWE scores improve in a majority (>80%) of Hepatitis C post prolonged cure with improvements ranging from 5.3% up to 85%. The exploration of factors that drive apparent progressive liver stiffness (scarring) is ongoing and will require larger study population analysis.