Determination of Real-world Single-center Experience with Direct-acting Antivirals for Improvement of Liver Fibrosis after Chronic Hepatitis C Treatment

Abstract

Background and Aims: Chronic Hepatitis C virus is the leading cause of morbidity and mortality. Conversion to liver fibrosis and decompensated liver cirrhosis is common if left untreated. Direct-acting Antiviral agents (DAA) may help in liver fibrosis associated burden. Considering the fact, this study aims to determine the comparative effect of combination therapy (Sofosbuvir and Daclatasvir vs. Sofosbuvir and Ribavirin) on liver fibrosis improvement using noninvasive marker AST platelet ratio index (APRI) score.
 Methods: A retrospective cross-sectional study was conducted on secondary data of patients who visited a private gastroenterology clinic during the year of 2017 and 2018 in Karachi, Pakistan. Our sample comprised of a total of 300 patients who presented for the first time to the clinic from various provinces.
 Results: Among all, 163 (54.3%) patients were treated with Sofosbuvir and Daclatasvir while 137 (45.6%) treated with Sofosbuvir and Ribavirin. The overall mean age and SD of patients was 41.1 ± 13.4 years and among them 64.6% (n = 194) were males. In both groups, treatment response showed negative HCV viral load after treatment, p <0.001. Levels of hemoglobin were significantly reduced in patients treated with Sofosbuvir and Ribavirin, 12.8gm/dL (11.5-14.2) vs. 11.4gm/dL (10.8-12.8), p value 0.03. Levels of total bilirubin significantly improved in patient received Sofosbuvir and Daclatasvir, 1.2mg/dL (0.4 - 1.8) vs. 0.6mg/dL (0.2 - 0.6), p value 0.001. Patients who treated with Sofosbuvir and Daclatasvir had significant improvement in APRI score (pre-treatment 1.26±0.17 vs. post-treatment 0.63±0.09, p value <0.001) in comparison with who treated with Sofosbuvir and Ribavirin (pre-treatment 0.92 ± 0.07 vs. post-treatment 0.43 ± 0.05, p value <0.06).
 Conclusion: In present study, we report that the value of APRI improved significantly after treatment with DAA particularly those who treated with Sofosbuvir and Daclatasvir, which may indicate that regression of fibrosis is achievable after removal of the causative agent.