Sustained Viral Response to Hepatitis C Direct Acting Anti-viral Therapy Is Associated With a Significant Regression of Fibrosis as Measured by Transient Elastography: Another Benefit of Cure

Abstract

Introduction: Hepatitis C (HCV) direct acting anti-viral therapy (DAA) is associated with a >90% sustained virological response rate (SVR) as defined by an undetectable hepatitis C viral load 12 weeks after completing therapy. Prior to initiation of DAA therapy, determination of the baseline fibrosis level is considered standard of care. After virological cure, the determination of the effect of SVR on fibrosis is not typically assessed yet it is critical for development of long term care goals in these patients. This study evaluated post-SVR fibrosis scores as measured by transient elastography (TE) in HCV pts having an SVR to DAA therapy to assess the effect of SVR on baseline fibrosis. Methods: Patients who achieved an SVR to DAA therapy were enrolled from a period of 12/2014-12/2016. All pts had baseline demographics, BMI, HCV genotype, HCVRNA, and ALT collected. TE was performed prior to initiation of DAA therapy and at least 12 weeks after completion of therapy in pts with SVR. Fibrosis was reported by the Metavir score and TE scores in kPa. Bridging fibrosis (F3) was defined as 7.5 - 12.4 kPa. Cirrhosis (F4) was defined as > 12.5 kPa. Results: 106 pts were enrolled. The mean baseline and post-SVR kPa scores were 10 and 8, respectively. Overall, 57% had fibrosis regression, 40% remained at the same fibrosis score, 3% had fibrosis progression. 38% regressed by 1 fibrosis stage, 17% by 2 stages and 2% by 3 stages. Of the pts with baseline cirrhosis (F4), 16/23 (70%) were no longer cirrhotic at follow up. 2 regressed from F4 to F1, 9 regressed from F4 to F2, 5 regressed from F4 to F3. 2 pts showed an increase in kPa score. Of the pts with baseline F3, 12/15 (80%) showed fibrosis regression. 5 regressed from F3 to F2, 7 regressed from F3 to F1. Of the pts with baseline F2, 16/22 (73%) had fibrosis regression. 13 regressed from F2 to F1, 2 regressed from F2 to F0. 4 remained at F2. 3 had fibrosis progression. Of the pts with baseline F1, 40/41 (44%) showed fibrosis regression. 17 regressed from F1 to F0. 1 had fibrosis progression to F2. All baseline F0 pts remained at F0. Conclusion: SVR to HCV DAA therapy is associated with significant improvement in fibrosis scores as measured by TE at all stages. 70% of cirrhotics had regression to non-cirrhotic states. Measurement of fibrosis by TE following SVR should be considered a standard part of the post-treatment evaluation as fibrosis regression has significant positive and cost saving implications on long term management of these pts.Table: Table. Results of fibrosis regression post SVR by transient elastography