Therapy with Oral Directly Acting Agents in Hepatitis C Infection Is Associated with Reduction in Fibrosis and Increase in Hepatic Steatosis on Transient Elastography

Abstract

Direct-Acting Antivirals (DAAs) are now the standard of care for management of Chronic Hepatitis C (CHC) infection. The aim of this study was to evaluate change in Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by transient elastography (FibroScan®) after completion of DAA therapy. LSM and CAP were measured serially (baseline pre-treatment, at 12 weeks post therapy, and one year after completion of therapy) in a prospective cohort of 372 CHC patients treated with DAAs. Patients with at least two FibroScan measurements were included. The mean age was 38.1±12.6 years; 58.3% males. Cirrhosis as defined by biopsy or fibroscan measurement (≥12.5)kPa was found in 25.5%. On paired analysis (n=317), LSM (IQR) decreased from a baseline value 7.1 (5.3-13.8)kPa to 6.2 (4.8-11.2)kPa 12 weeks post therapy with a median decline 0.7 (-0.6-2.6)kPa, P<0.001. Similarly, on paired analysis (n=160), LSM decreased from baseline 6.9 (5.1-12.7)kPa to 6.1 (4.8-9.4)kPa after one year of treatment with median decline 0.9 (-0.6-3.2)kPa, P<0.001. In contrast, on paired analysis (n=317), CAP increased from baseline of 213.0 (180.0-254.5)dB/m to 225.0 (190.0-269.0)dB/m at 12 weeks post therapy with median increase 7.0 (-23.5-45.5), P=0.001. Similarly, on paired analysis (n=160), CAP increased from baseline of 210.0 (180.3-260.8)dB/m to 234.0 (204.0-282.0)dB/m at one year post therapy with median increase 25.0 (-12.5-61.5)dB/m, P<0.001. On multivariate linear regression analysis, low baseline CAP value and low albumin were significantly associated with increase in CAP values. Treatment with DAAs reduces liver stiffness, but is associated with increase in hepatic steatosis.