Abstract
BackgroundStudies on temporal changes in noninvasive fibrosis indices and liver stiffness measurement (LSM) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral agents (DAAs) are limited.MethodsWe retrospectively enrolled consecutive patients with CHC who had received DAAs.ResultsIn total, we recruited 395 consecutive patients, of which 388 (98.2%) achieved a sustained virologic response (SVR) at 12 weeks after therapy. In patients who received DAA therapy and achieved SVR 12 weeks after therapy (n = 388), the median aspartate aminotransferase/platelet ratio index (APRI) value decreased from 1.19 (0.62–2.44) at baseline to 0.50 (0.32–0.95), 0.51 (0.31–0.92), 0.48 (0.31–0.88), and 0.52 (0.33–0.92) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median FIB-4 value decreased from 2.88 (1.56–5.60) at baseline to 2.10 (1.30–3.65), 2.15 (1.30–3.65), 2.11 (1.37–3.76), and 2.22 (1.45–3.82) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median alanine aminotransferase level significantly decreased from week 2 until PW12 (all P < 0.001). The platelet count significantly increased from 2 weeks after DAA therapy initiation until PW12 (all P < 0.001); however, the magnitude of changes in the platelet count was low. In patients with paired LSMs obtained using acoustic radiation force impulse elastography at baseline and PW12 (n = 199), the median LSM decreased from 1.78 (1.25–2.30) m/s at baseline to 1.38 (1.14–1.88) m/s at PW12 (P < 0.001).ConclusionsNoninvasive fibrosis indices, namely APRI and FIB-4, exhibited a rapid and sustained decline from week 2 until PW12 in patients with CHC who achieved SVR to DAA therapy. The rapid decline in APRI and FIB-4 values might mainly result from improvement in necroinflammation.
Highlights
Studies on temporal changes in noninvasive fibrosis indices and liver stiffness measurement (LSM) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral agents (DAAs) are limited
The platelet count significantly increased from 2 weeks after DAA therapy initiation until 12 weeks after therapy (PW12); the magnitude of changes in the platelet count was low
The present study investigated the temporal effect of DAAs on the noninvasive index values of patients with CHC at baseline, week 2, week 4, end of therapy (EOT), and 12 weeks after therapy (PW12) and identified factors associated with these changes
Summary
Studies on temporal changes in noninvasive fibrosis indices and liver stiffness measurement (LSM) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral agents (DAAs) are limited. Owing to the invasive nature of liver biopsy, many noninvasive fibrosis indices have been developed to assess the stage of liver fibrosis [2] Among these indices, the aspartate aminotransferase (AST)/platelet ratio index (APRI) [3] and FIB-4 index [4] are commonly used. Before the advent of direct-acting antiviral agents (DAAs), a combination therapy with pegylated interferon-α (Peg-IFN) and ribavirin (RBV) was the standard of care for patients with CHC [7, 8]. This combination therapy significantly reduced hepatic necroinflammation and liver fibrosis progression in patients with CHC [9].
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