Abstract
This study aimed to observe the effect of the direct-acting antiviral (DAA) therapy on liver stiffness (LS) and serum biomarkers. We prospectively observed 35 patients with chronic hepatitis C infection and attained a sustained virological response (SVR) after antiviral therapy. Shear wave elastography (SWE) measurement was performed at the beginning of DAA treatment and at 48 weeks after the end of treatment (EOT48w). The METAVIR score and the score for varices needing treatment (VNT) were determined based on the LS values; the fibrosis-4 (FIB4) score was calculated from laboratory tests. The baseline LS (mean ± standard deviation = 2.59 ± 0.89 m/s) decreased significantly after successful DAA therapy (1.90 ± 0.50 m/s; p < 0.001). The METAVIR score showed significant improvement at EOT48w (F0/1 = 9, F2 = 2, F3 = 10, F4 = 14) compared to the initial status (F0/1 = 2, F2 = 1, F3 = 7, F4 = 25; p < 0.028). The FIB4 score indicated less fibrosis after therapy (2.04 ± 1.12) than at baseline (3.51 ± 2.24; p < 0.018). Meanwhile, the number of patients with a high-risk of VNT was significantly less at EOT48w (4 vs. 15 at baseline; OR = 0.17 95% confidence interval (CI) = 0.05–0.59, p < 0.007). SWE indicates a significant resolution of liver fibrosis when chronic hepatitis C patients are in SVR, coinciding with a lower risk of VNT.
Highlights
Hepatitis C infection (HCV) is a major cause of liver morbidity worldwide, with approximately 71 million chronically infected patients
We aimed to show that Shear wave elastography (SWE) can re-evaluate risk factors of cirrhosis-associated complications in sustained virological response (SVR)
The METAVIR score was calculated at each time point based on the SWE measurements, and it showed significant improvement (p < 0.028) after treatment (F0/1 = 9, F2 = 2, F3 = 10, F4 = 14)
Summary
Hepatitis C infection (HCV) is a major cause of liver morbidity worldwide, with approximately 71 million chronically infected patients. The therapeutic efficiency of DAAs is significantly higher than previous IFN-based regimens, with an eradication rate as high as 90% in non-cirrhotic patients. Assessment of liver fibrosis is of high importance prior to therapy. The diagnosis of advanced fibrosis (METAVIR stage F3) and cirrhosis (METAVIR stage F4) can alter the choice of a treatment regimen, the therapeutic response rate, and the post-treatment prognosis in affected patients [2,4]. International guidelines recommend the treatment of all HCV-infected patients and emphasize that those with significant liver fibrosis or cirrhosis must be considered for treatment without delay. Shear wave elastography (SWE) is a universally accepted non-invasive technique for the staging of fibrosis in chronic hepatitis
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