Regression of liver fibrosis over a 24-wk period after completing direct-acting antiviral therapy in patients with HCV receiving care within the national hepatitis C elimination program in Georgia

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September 8, 2017

DAA therapy for chronic HCV  infection results in liver stiffness regression over 12 months post-treatment

In summary, our study found that successful treatment of chronic HCV with DAA therapy is associated with improvement in liver stiffness, assessed by VCTE measured serially over the first 12 months after treatment. Continued improvement in VCTE scores between EOT and12 months post-treatment suggests possible early regression of fibrosis in addition to resolution of inflammation that occurs soon after starting HCV therapy. Longer-term data are needed to determine whether improvement in liver stiffness continues beyond 1 year, and larger studies are needed to elucidate factors associated with rapidity and magnitude of improvement.

Regression of liver fibrosis over a 24-week period after completing direct-acting antiviral therapy in patients with chronic hepatitis C receiving care within the national hepatitis C elimination program in Georgia: results of hepatology clinic HEPA experience.

Dolmazashvili E, et al. Eur J Gastroenterol Hepatol. 2017.

Eur J Gastroenterol Hepatol. 2017 Aug 29. doi: 10.1097/MEG.0000000000000964.

[Epub ahead of print]

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Abstract
OBJECTIVE: We assessed the impact of direct-acting antiviral (DAA) therapy on liver fibrosis regression measured by transient elastography (TE) in patients with chronic hepatitis C virus (HCV) infection.

PATIENTS AND METHODS: A prospective cohort study was carried out in HCV monoinfected patients with advanced liver fibrosis or cirrhosis receiving interferon (IFN)-containing or IFN-free DAA therapy. Liver stiffness (LS) score more than 14.5 kPa indicated LS-defined cirrhosis. The primary outcome was improvement in liver stiffness measurement (LSM) at week 24 after treatment measured as (a) decrease in the median LS compared with baseline and (b) at least a 20% decrease in LSM compared with baseline. A multivariate logistic regression model was utilized to identify the factors associated with at least a 20% improvement in LSM.

RESULTS: Of a total of 304 patients, 172 (56.6%) had LS-defined cirrhosis before treatment. LSM decreased from the baseline median value of 16.9 (interquartile range: 11.8-27.7) kPa to a post-treatment week 24 score of 11.9 (interquartile range: 8.2-20.9) kPa (P<0.0001). Of a total of 304 patients, 198 (65.1%) achieved at least a 20% reduction in LS. In multivariate logistic regression analysis, sustained virological response (SVR) was associated significantly with this reduction (P<0.0001). The addition of IFN to the treatment regimen had no impact on the decrease in LSM. Despite decreasing baseline LSM, more than half of the LS-defined cirrhotic patients remained cirrhotic at week 24 after treatment.

CONCLUSION: In patients with advanced fibrosis, pretreatment LS significantly reduced during DAA therapy. SVR was the only independent factor associated with the regression in LSM. However, irrespective of achieving SVR, liver damage still persisted in a substantial proportion of patients. Thus, early treatment of HCV-infected patients can significantly prevent residual liver damage.