S1001 FIB-4 Regression With Direct-Acting Antiviral Therapy in Patients With Hepatitis C Infection

Abstract

INTRODUCTION: Chronic hepatitis C virus (HCV) can lead to cirrhosis and hepatocellular carcinoma. Liver fibrosis stage determines the risk of morbidity and mortality from chronic HCV infection. Direct acting antiviral (DAA) agents are highly effective in virus eradication. Our primary aim is to evaluate the effect of treatment with DAAs on non-invasive liver fibrosis measurement using Fibrosis-4 (FIB-4) scores. Our secondary aim was to identify comorbid conditions that may influence the rate of liver fibrosis regression. METHODS: This is a retrospective cohort study. We identified 343 patients who initiated HCV treatment with DAAs from 2016 to 2018 and achieved a sustained viral response (SVR). FIB4 scores were calculated at baseline before initiating DAAs, and one year after achieving SVR. We categorized patients based on the following FIB-4 scores: Baseline FIB-4 ≥3.25 and after treatment FIB-4 < 3.25. We evaluated whether the presence of other comorbid conditions influenced liver fibrosis regression, including insulin resistance, type 2 diabetes mellitus, non-alcoholic fatty liver disease (NAFLD), both alcoholic fatty liver disease (BAFLD), and history of alcohol use disorder. We presented categorical data as frequencies and percentages of the total. In prespecified subgroup analysis we ran linear mixed-model analysis of variance (ANOVA) models with restricted maximum likelihood estimation.Statistical analysis was performed with SPSS and SAS version 9.4. Significance was defined as the 2-tailed value of P < 0.05. RESULTS: There was a statistically significant drop in mean FIB-4 score from baseline to post-SVR (3.45 ± 2.84 vs 2.28 ± 1.60, P < 0.001). 117 patients had baseline FIB-4 scores > 3.25, 56% had FIB-4 scores < 3.25 after SVR. Alcohol use disorder was associated with a higher baseline FIB-4 score compared to low level drinking (3.85 ± 0.20 vs.3.15 ± 0.16). These patients showed greater improvement in FIB-4 scores after treatment when compared to those without alcohol use disorder (1.44 + 0.15 vs. 0.97 ± 0.13, P = 0.02). CONCLUSION: FIB-4 index is a useful non-invasive tool for monitoring fibrosis regression after antiviral therapy. Patients with a history of alcohol abuse had the greatest reduction in FIB-4 score post-SVR.Table 1Figure 1Figure 2