Abstract
Background:During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Transient Elastography (TE) is a clinical measure of liver stiffness that facilitates evaluation of liver damage stage. While a portion of the TE score is attributable to liver fibrosis and relatively irreversible damage, another component of the TE score is attributable to liver inflammation or edema. Markers of inflammation during chronic HCV infection include soluble markers of immune activation, which are also associated with morbid outcome (including cardiovascular disease and liver-disease progression). Whether soluble markers of immune activation or changes in their level during HCV therapy relate to normalization of AST, ALT, Albumin, or TE score, is not clear.Methods:We evaluated soluble markers of immune activation (plasma sCD14, IL-6, sCD163, autotaxin [ATX], and Mac2BP) and TE score, and their relationship in 20 HCV-infected patients before, during, and after HCV-directed IFN-free direct-acting antiviral (DAA) therapy. We evaluated normalization of parameters and the relationship between each over a 6-month window.Results:Before therapy, serum AST levels positively correlated with plasma levels of sCD14, sCD163, and Mac2BP, while ALT levels positively correlated with Mac2BP. Serum albumin level negatively correlated with plasma IL-6 and ATX levels. IFN-free therapy uniformly resulted in sustained virological response at 12 and 24 weeks after therapy completion. After initiation of therapy AST and ALT normalized, while levels of ATX, Mac2BP, sCD163, and TE score partially normalized over 6 months. Additionally, change in AST level and APRI score correlated with change in sCD163, IL-6, and Mac2BP levels, and change in ALT correlated with change in IL-6 and Mac2BP levels. Improvement in TE score correlated with a decrease in the level of sCD14 at week 4, and almost statistically significant with decrease in sCD14 at weeks 20-24 after initiation of IFN-free HCV therapy.Conclusions:Soluble markers of immune activation normalize or partially normalize at different rates after initiation of curative HCV DAA therapy, and TE scores improve, with wide variability in the degree of absolute improvement in liver stiffness from patient to patient. Decline magnitude of sCD14 was associated with improvement in TE score, while magnitude of improvement in AST correlated with reduction in sCD163 levels. These data provide support for a model where monocyte/Kupffer cell activation may account for a portion of the liver inflammation and edema, which is at least partially reversible following initiation of HCV DAA therapy.
Highlights
Chronic hepatitis C infection is the most common cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma (HCC) in the United States [1, 2]
Serum level of AST and APRI score positively correlated with sCD14, soluble CD163 (sCD163), and Mac2BP (Table 2, AST: r = 0.650, P = 0.016; r = 0.591, P = 0.012; r = 0.565, P = 0.028; APRI: r = 0.560, P = 0.049; r = 0.750, P = 0.001; r = 0.586, P = 0.022 respectively), while ALT positively correlated with Mac2BP (r = 0.705, P = 0.007)
Albumin level negatively correlated with IL-6 and ATX level (r = -0.631, P = 0.012; and r = -0.494, P = 0.05; respectively)
Summary
Chronic hepatitis C infection is the most common cause of cirrhosis, end-stage liver disease, and hepatocellular carcinoma (HCC) in the United States [1, 2]. Patients who achieve SVR have a significantly lower incidence of HCC compared to those without SVR, but the absolute risk for HCC is still high in those with cirrhosis despite SVR [9]. Since patients with HCV associated cirrhosis who achieve SVR with IFN-free therapy remain at high risk for HCC, current standard practice is to regularly screen these patients for HCC using ultrasound, MRI, or CT scan imaging. During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Markers of inflammation during chronic HCV infection include soluble markers of immune activation, which are associated with morbid outcome (including cardiovascular disease and liver-disease progression). Whether soluble markers of immune activation or changes in their level during HCV therapy relate to normalization of AST, ALT, Albumin, or TE score, is not clear
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