S1058 Impact of Hepatitis C Treatment With Direct-Acting Antiviral Agents on Liver Stiffness Using Vibration-Controlled Transient Elastography and Fibrosis-4 Scores: A Prospective Study in the U.S. Veteran Population

Abstract

INTRODUCTION: Successful treatment of chronic Hepatitis C (CHC) is measured by sustained viral response (SVR) at 12 and/or 24 weeks after treatment with Direct Acting Antiviral Agents (DAAs). We assessed for improvement in liver stiffness following CHC treatment using vibration controlled transient elastography (VCTE) and Fibrosis 4 Score (Fib-4). METHODS: This was a prospective cohort study conducted by the GI Dept. at Dayton Veterans Affair Medical Center (VAMC). Stages for Liver Stiffness Measurement (LSM) obtained by VCTE were:F0 ≤ 6 kPa, F1–F2 = 6.1–9.4 kPa, F3 = 9.5–12.4 kPa and F4 (cirrhosis) ≥12.5 kPa. Stages for Fib-4 scores were:F0–F1 < 1.45, F2–F3 = 1.45–3.25, ≥ F4 (advanced fibrosis) > 3.25. Veterans who underwent SVR 12 and/or 24 after treatment with DAAs and had a pre-treatment LSM between January 1, 2014 and December 31, 2017 were included. Veterans who met the inclusion criteria and consented to a 2 year post SVR follow up VCTE were enrolled. Exclusion criteria were BMI > 32, co-existing Hepatitis B, poor quality VCTE, incomplete study values, and death. 204 patients were enrolled and 64 were included in analysis. RESULTS: CHC treatment with DAAs showed statistically significant improvement in fibrosis. For VCTE, median LSM was 11.85 kPa (IQR/M 3–27%) and 6.40 kPa (IQR 3–28%) [P < 0.001] before and after DAA treatment. Median Fib-4 scores were 2.08 and 1.41 before and after DAA treatment [p=< 0.001]. LSM from VCTE showed 76.9% (95% CI = 58.0%–89.0%, N0 = 26, N1 = 20) of patients at stage F4 had at least 1 stage improvement and 50% (95% CI = 32.1%–67.9%, N0 = 26, N1 = 13) showed 2 stage improvement. Fib-4 showed 73.3% (95% CI = 48.1%–89.1%; N0 = 15, N1 = 11) with 1 stage improvement and 6.7 % (95% CI = 1.2–29.8%; N0 = 15, N1 = 1) with 2 stage improvement. When all stages of fibrosis were included, 1 stage improvement was noted in 78.1% of patients on LSM (95% CI = 65.7–87.1%) and 62.5% of patients on Fib-4 score (CI = 48.4%–74.8%). There were no differences in variables such as BMI, alcohol use, underlying diabetes, statin use, pre-treatment fibrosis stage, viral load or genotype between those who had 1 stage improvement in fibrosis vs those who did not. 31 of 45 (68.9%, 95% CI = 53.2%–81.4%) had concordant findings on VCTE and Fib-4 score and 14 patients did not. CONCLUSION: Successful CHC treatment with DAAs results in fibrosis improvement by at least 1 stage as measured by VCTE and Fib-4. This improvement occurs regardless of variables such as BMI, presence of diabetes, or alcohol use.