Comparison of liver biopsies before and after direct-acting antiviral therapy for hepatitis C and correlation with clinical outcome

Abstract

Direct-acting antivirals (DAA) have replaced interferon (IFN)-based therapies for hepatitis C virus. In this retrospective clinical study, we examined differences in histopathologic features in paired liver biopsies collected from the same patient before and after DAA and correlated these findings with clinical outcome. Biopsies (n = 19) were evaluated by quantitative imaging analysis to measure steatosis and fibrosis. Most patients had decreased steatosis in their post-treatment, follow-up biopsies. However, one patient had a striking increase in steatosis (from 0.86 to 6.32%) and later developed decompensated cirrhosis and hepatocellular carcinoma (HCC). This patient had a marked increase in fibrosis between biopsies, with a CPA of 6.74 to 32.02. Another patient, who already had bridging fibrosis at the time of her pre-treatment biopsy, developed cholangiocarcinoma after DAA. Even though the overall inflammatory activity in the post-treatment biopsies significantly decreased after treatment, 60% of patients had persistent portal lymphocytic inflammation. In summary, DAAs decreased steatosis and hepatic inflammation in most patients, although some may have persistence of lymphocytic portal inflammation. Patients known to have advanced fibrosis at treatment initiation and who have other risk factors for ongoing liver injury, such as steatosis, should be followed closely for the development of adverse outcomes, such as portal hypertension and primary liver cancers.

Role of Inflammatory/Immune Response and Cytokine Polymorphisms in the Severity of Chronic Hepatitis C (CHC) before and after Direct Acting Antiviral (DAAs) Treatment

“…As expected, in our study, higher values of AST, ALT, and ALP were associated with more advanced fibrosis stages before and after DAA treatment. These results agree with other studies that report a normalization of these biomarkers after HCV elimination [ 19 , 20 ].…”

Changes in Liver Steatosis Using Controlled Attenuation Parameter among Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals Therapy Who Achieved Sustained Virological Response

“…Furthermore, the HCVinfected patients with superimposed conditions such as metabolic syndrome and obesity should be evaluated for liver steatosis after SVR [26]. In several studies, the hepatic steatosis in HCV patients before SVR was assessed by liver biopsy, and 40-80% of cases had liver steatosis [27,28]. In our study, the prevalence of liver steatosis in patients who achieved SVR with DAAs was 66,42%, independent of the type of regimen used.…”

Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: A systematic review

“…The majority of studies (21 out of 30) did not show a significant change in mean BMI or weight after SVR. Conversely, 7 studies revealed an increase in BMI after SVR, 27,40,90,114–117 while 3 studies showed a reduction in mean BMI 53,81,118 …”