Abstract
BackgroundA large number of chronic hepatitis C patients had been successfully treated by directly acting antivirals; therefore, strategies for the long-term follow-up of these patients have to be planned based on the post-treatment fibrosis stage—the main determinant of prognosis. In this study, we aim to evaluate changes in aspartate-platelet ratio index, FIB4, and liver stiffness in chronic hepatitis C patients who achieved SVR and ended treatment more than 1 year by DAAs.ResultsOne hundred chronic hepatitis C patients who achieved SVR were enrolled at a median of 16 months after the end of treatment by DAAs. According to the baseline liver stiffness, 63 and 37 patients belonged to early (F0, F1, and F2) and advanced (F3 and F4) fibrosis stages, respectively. Both groups showed a decline of the degree of liver stiffness at follow-up compared to the baseline that was statistically significant in the early fibrosis group (5.9±1.5 vs 5.4±2.2 Kpcal, p=0.04), while measurements in the advanced group were (18±8.8 vs 15.9 ± 7.8 Kpcal, p=0.07). Also, serum biomarkers of fibrosis improved in both groups, where the recorded APRI and FIB4 before and after treatment were 0.42±0.3 vs 0.24±0.1, p<0.01 and 1±0.6 vs 0.93 ±0.5, p=0.1 in the early group and 0.85 ±0.5 vs 0.4±0.2, p <0.001 and 2.9±2.3 vs 1.8±1.4, p<0.02) in the advanced group, respectively. Changes in APRI and FIB4 correlated with changes in AST and ALT, but liver stiffness changes were not affected by changes in liver enzymes.ConclusionAlthough long-term improvement of APRI, FIB4, and liver stiffness scores could be achieved in chronic HCV patients after SVR by DAAS. High measurements of liver stiffness before treatment likely persist. We recommend transient elastography as a reliable tool for fibrosis assessment post-treatment.
Highlights
A large number of chronic hepatitis C patients had been successfully treated by directly acting antivirals; strategies for the long-term follow-up of these patients have to be planned based on the posttreatment fibrosis stage—the main determinant of prognosis
During the time period from October 2017 to December 2018, 120 chronic Hepatitis C virus (HCV) patients attended our clinic for follow-up after the end of treatment with DAAs, only 100 patients fulfilled the inclusion criteria and were enrolled in this study while 20 patients were excluded, as 2 were relapsers, 7 developed HCC and/or ascites while 11 patients refused to participate
As posttreatment prognosis is mainly determined by the fibrosis stage, many studies have been conducted to evaluate whether regression of fibrosis can be achieved after completion of DAAS therapy; most of these studies were done at a short duration after the end of treatment (12 and 24 weeks ) [14, 15]
Summary
A large number of chronic hepatitis C patients had been successfully treated by directly acting antivirals; strategies for the long-term follow-up of these patients have to be planned based on the posttreatment fibrosis stage—the main determinant of prognosis. We aim to evaluate changes in aspartate-platelet ratio index, FIB4, and liver stiffness in chronic hepatitis C patients who achieved SVR and ended treatment more than 1 year by DAAs. Hepatitis C virus (HCV) chronic infection is an important etiology of chronic liver disease that is prevalent worldwide; discovering an effective antiviral therapy was a major target for research [1]. Many studies discussed the possibility of fibrosis regression following sustained virological response (SVR) achievement by DAAs which is debatable [4]. Chronic HCV infection and the resultant hepatocyte injury induce an inflammatory response that produces cytokines leading to stimulation of hepatic stellate cells (HSC) and fibrogenesis initiation, and elimination of the injurious agent would halt this inflammatory process. Fibrosis regression would depend on apoptosis of activated HSC and degradation of the extracellular matrix which is affected by the duration and components of the scar tissue [5]
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