Abstract

Aim The success of direct-acting antivirals (DAAs) against hepatitis C virus is a major breakthrough in hepatology. Previous studies have shown that chitinase 3-like protein 1 (CHI3L1) was a marker for staging of liver fibrosis caused by HCV. In this investigation, we used CHI3L1 as a surrogate marker to compare dynamic hepatic fibrosis variations following the elimination of HCV among cases receiving sofosbuvir (SOF)-based regimens and pegylated interferon/ribavirin (PR) treatments. Methods The study enrolled 105 patients, including 46 SOF-based regimens treated patients, 34 PR-experienced patients, and 25 untreated patients. Serum samples and clinical data were obtained at the baseline, the end of treatment, and at weeks 24 and 48 after treatments. Results First, we found that serum level of CHI3L1 correlated moderately but significantly with LSM (r = 0.615, P < 0.001) at the baseline, and diagnosed liver cirrhosis at baseline with high accuracy (AUC = 0.939) by ROC analysis. So we explored CHI3L1 as a sensitive biomarker to monitor the regression of liver fibrosis after HCV eradication. We found that the serum CHI3L1 level of CHC cases receiving SOF-based regimen treatments was markedly reduced immediately after treatment compared with that at the baseline (123.79 (118.55) vs. 118.20 (103.68), P = 0.001). For cases undergoing PR treatment, the serum CHI3L1 decreased significantly at week 24 posttreatment compared with that at the baseline (69.98 (51.44) vs 89.15 (110.59), P = 0.016). For the untreated cirrhotic patients, CHI3L1 levels increased at week 96 follow-up compared with that at the baseline (194.73 (172.46) vs. 89.50 (242.97), P = 0.048), reflecting continued worsening of liver fibrosis. Conclusion CHI3L1 is suggested to be the sensitive marker to monitor fibrosis variations in weeks during treatments and after achieving SVR. It has the potential to allow the identification of early treatment failure for a timely switch to alternative treatment and to allow monitoring progression of fibrosis as a risk factor for liver cirrhosis.

Highlights

  • Infection with chronic hepatitis C (CHC) is still a notable burden in the world

  • Repeated biopsy is the method used to evaluate the worsening of liver fibrosis or monitor the progression of liver fibrosis in many previous studies [3, 15]

  • There is an urgent need for a better noninvasive method to monitor the progression of liver fibrosis after sustained virological response (SVR) in CHC patients

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Summary

Introduction

As estimated by the World Health Organization (WHO), 71 million people in the world suffer from infection with hepatitis C virus (HCV) in 2015; besides, 399,000 people die of HCV infection-induced hepatocellular carcinoma (HCC) or cirrhosis. Previous studies have shown that after receiving IFN-based treatment regimens to obtain SVR, CHC patients’ liver fibrosis (LF) progression was reversed or halted, resulting in decreased incidence rates of HCC and other liverrelated complications, as well as enhanced quality of life related to health [3, 4]. There have been reports showing that, for patients with HCV infection-related cirrhosis, HCV infection resolution induced by DAA shows no Disease Markers effect on diminishing HCC occurrence, and those with HCC are still associated with an increased risk of short-term tumor relapse [5, 6]

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