How many HCV cirrhotic patients go below cirrhotic cut-off values in transient elastography after direct acting agents treatment?

Abstract

Introduction Liver stiffness (LS) measurements by Transient Elastography (TE) has been accepted as a tool for fibrosis assessment. The aim of the study was to evaluate what happens with liver stiffness values after DAA (Direct-acting antivirals) therapy, in patients with compensated HCV cirrhosis, who had sustained virologic response (SVR) and to highlight in how many LS values become lower than the accepted cut-off for cirrhosis. Material & Method A number of 167 patients with compensated HCV cirrhosis who had LS > 12 kPa at baseline, underwent a 12 weeks DAA therapy (Viekirax/Exviera) and had SVR. 56 of them were followed up by TE 24 weeks after EOT (end of treatment) and also 48 weeks after EOT (SVR 48). A subgroup of 28 patients were followed up 96 weeks after EOT (SVR 96). LS values were assessed by means of TE (FibroScan, Echosens) at the start of treatment (ST), at SVR 12 (12 weeks from EOT), SVR 24, SVR 48 and SVR 96, respectively. In each session, 10 valid liver stiffness measurements (LSM) were obtained and reliable LSM were defined as median value of 10 measurements with Interquartile range/median (IQR/M) ≤ 30%. Results LS mean values at SVR12 were significantly lower as compared to ST (16.6 ± 6.87 kPa vs 21.3 ± 8.8, p = 0.002). As compared to SVR12, at SVR24 the mean LS values remained stable (16.6 ± 6.87 vs 16.9 ± 6.87 kPa, p = 0.81) and at SVR48 the values continued to decrease, but without statistical significance (14.6 ± 5.3 vs 16.6 ± 6.87 kPa, p = 0.08). LS was Conclusion In compensated HCV cirrhotic patients, the mean LS values significantly decreased at SVR12, remained stable at SVR24 and decreased at SVR48; 14 % patients had LS values