Saturday, October 14, 2017

Noninvasive Assessment of Fibrosis Regression in Hepatitis C Virus Sustained Virologic Responders

Gastroenterology & Hepatology
October 2017 - Volume 13, Issue 10
Gastroenterology & Hepatology (G&H) is a monthly peer-reviewed journal reaching nearly 18,000 gastroenterologists and hepatologists. G&H provides editorial content encompassing a wide array of topics relevant and useful to the fields of gastroenterology and hepatology, both separately and together. Content is directed by the strong input of today’s top thought leaders in gastroenterology and hepatology, including feature-length review articles and monthly columns consisting of engaging interviews with experts on current issues in inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), hepatology, and endoscopy. G&H also publishes industry-supported meeting highlights, clinical roundtable monographs, and clinical review supplements. The journal and all affiliated supplements are included in the National Library of Medicine’s PubMed/MEDLINE index as well as EMBASE.

Noninvasive Assessment of Fibrosis Regression in Hepatitis C Virus Sustained Virologic Responders
Hirsh D. Trivedi, MD, Steven C. Lin, MD, and Daryl T. Y. Lau, MD, MSc, MPH


Hepatitis C virus, fibrosis, noninvasive serum fibrosis markers, vibration-controlled transient elastography, magnetic resonance elastography

The emergence of direct-acting antiviral (DAA) therapies and noninvasive measures of liver fibrosis has streamlined the management of patients with chronic hepatitis C virus (HCV) infection. DAA therapy is associated with a significantly higher rate of sustained virologic response (SVR) compared to interferon-based therapies. Concomitantly, validated noninvasive measures of fibrosis allow evaluation of patients for therapy without an invasive liver biopsy. Noninvasive measures of fibrosis can be classified as serologic tests or imaging modalities. Several serologic tests have shown robust reliability and clinical applicability. Similarly, imaging modalities such as vibration-controlled transient elastography and magnetic resonance elastography can be used to assess liver stiffness and correlate with fibrosis. Combinations of serologic and imaging tests further improve accuracy compared to an individual modality. The availability of noninvasive fibrosis measures coupled with high SVR rates has shifted the paradigm in the management of HCV infection in the DAA era. Although these noninvasive tests are valuable in evaluating hepatic fibrosis prior to HCV therapy, use of these measures in monitoring fibrosis regression after HCV eradication is currently limited. Furthermore, for patients with pretreatment cirrhosis, the association between fibrosis regression after successful therapy and the risk of hepatocellular carcinoma (HCC) over time is unclear. There are no guidelines on long-term fibrosis monitoring and HCC surveillance after SVR is achieved. This article summarizes the current data on the applications of noninvasive methods to measure hepatic fibrosis and portal hypertension in HCV. In addition, a road map is provided for monitoring patients with advanced fibrosis after HCV eradication.

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