Improvement in hepatitis C virus patients with advanced, compensated liver disease after sustained virological response to direct acting antivirals.

Abstract

The outcome of patients with chronic hepatitis C virus infection (HCV) and advanced, compensated liver disease after sustained virological response (SVR) to direct-acting antivirals (DAAs) has not yet been completely depicted. We aimed to assess the clinical, biochemical and instrumental outcome of patients with advanced, compensated chronic HCV-related liver disease with DAA-induced SVR to DAAs and who had at least 1-year follow-up. Fifty-two patients with cirrhosis (n=27) and fibrosis stage F3 (n=25) followed up for a median of 60weeks after successful DAA treatment were included. Laboratory work-up, including APRI and FIB-4 scores, liver transient elastography and measurement of the spleen bi-polar diameter were carried out before treatment and at the end of follow-up. Liver stiffness decreased (P<0.0001) from a median baseline of 15.2kPa (12.0-20.0) to 9.3kPa (7.5-12.0) at follow-up. A liver stiffness value suggestive of the presence (ie, ≥21.0kPa) of clinically significant portal hypertension was found in 13 patients (25.0%) at baseline and in seven patients (13.5%) at follow-up (P=0.037). Both APRI (P<0.0001) and FIB-4 score (P=0.025) progressively decreased, while platelet count increased (143×109 /L [117-176] to 153×109 /L [139-186], P=0.003), and spleen bi-polar diameter decreased (120mm [112-123] to 110mm [102-116], P=0.0009) from baseline to the end of follow-up. In patients advanced, compensated chronic liver disease, liver stiffness significantly improves in the long-term after SVR, and this improvement is accompanied by an amelioration of indirect indices of liver fibrosis and function, and by a decrease in parameters of portal hypertension.