Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

Casado, José L.; Esteban, María Ángeles; Bañón, Sara; Moreno, Ana; Pérez-Elías, María Jesús; Mateos, María Luisa; Moreno, Santiago; Quereda, Carmen

doi:10.1007/s10620-015-3773-y

Cited by 15 publications

(14 citation statements)

References 33 publications

(57 reference statements)

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“…Treatment regimens for HCV are rapidly changing, and there is a great need for further studies on the effect of each regimen on liver fibrosis. Fibrosis regression has been shown to decrease the risk of HCC and mortality [ 14 , 41 ], but many patients are offered HCV treatment after fibrosis has been established. Since our study found persistently elevated LS in many patients, early diagnosis and treatment before fibrosis has been established is necessary to maximize the benefits of treatment.…”

Section: Discussionmentioning

confidence: 99%

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus

et al. 2016

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Background and AimTo investigate the impact of a sustained virological response (SVR) to hepatitis C virus (HCV) treatment on liver stiffness (LS).MethodsLS, measured by transient elastography (FibroScan), demographic and laboratory data of patients treated with interferon (IFN)-containing or IFN-free regimens who had an SVR24 (undetectable HCV viral load 24 weeks after the end of treatment) were analyzed using two-tailed paired t-tests, Mann-Whitney Wilcoxon Signed-rank tests and linear regression. Two time intervals were investigated: pre-treatment to SVR24 and SVR24 to the end of follow-up. LS scores ≥ 12.5 kPa indicated LS-defined cirrhosis. A p-value below 0.05 was considered statistically significant.ResultsThe median age of the patients (n = 100) was 60 years [IQR (interquartile range) 54–64); 72% were male; 60% were Caucasian; and 42% had cirrhosis pre-treatment according to the FibroScan measurement. The median LS score dropped from 10.40 kPa (IQR: 7.25–18.60) pre-treatment to 7.60 kPa (IQR: 5.60–12.38) at SVR24, p <0.01. Among the 42 patients with LS-defined cirrhosis pre-treatment, 25 (60%) of patients still had LS scores ≥ 12.5 kPa at SVR24, indicating the persistence of cirrhosis. The median change in LS was similar in patients receiving IFN-containing and IFN-free regimens: -1.95 kPa (IQR: -5.75 –-0.38) versus -2.40 kPa (IQR: -7.70 –-0.23), p = 0.74. Among 56 patients with a post-SVR24 LS measurement, the LS score changed by an additional -0.90 kPa (IQR: -2.98–0.5) during a median follow-up time of 1.17 (IQR: 0.88–1.63) years, which was not a statistically significant decrease (p = 0.99).ConclusionsLS decreased from pre-treatment to SVR24, but did not decrease significantly during additional follow-up. Earlier treatment may be needed to reduce the burden of liver disease.

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Section: Discussionmentioning

confidence: 99%

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus

et al. 2016

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“…While cirrhosis-related complications did not occur among patients who regressed from METAVIR F4 to 6F2, the incidence of cirrhosis-related complications per 100 person-years was 4 among those who remained with F3 or F4 after therapy (p = 0.002). Although limited by the use of transient elastography for fibrosis regression assessment, the link between fibrosis regression and beneficial clinical outcome was recently confirmed among patients with a HCV-HIV coinfection [46]. Histological improvement may also explain the reduction in the hepatic venous pressure gradient (HVPG) which has been observed following HCV eradication with IFN-based therapy [47,48].…”

Section: Regression Of Hepatic Fibrosis and Cirrhosis Following Svrmentioning

confidence: 99%

Reversion of disease manifestations after HCV eradication

Meer

Berenguer

2016

Journal of Hepatology

157

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Chronic infection with the hepatitis C virus (HCV) may lead to hepatic fibrosis and eventually cirrhosis, at which stage, patients have a substantial risk of liver failure, hepatocellular carcinoma (HCC) and liver-related death. Moreover, HCV infection is associated with several extrahepatic manifestations which impact the quality of life and increase the non-liver-related mortality rate. For patients with compensated liver disease, interferon (IFN)-based antiviral therapy has been a treatment option for over two decades. Long-term follow-up studies indicated that among those with sustained virological response (SVR) the extend of hepatic fibrosis can regress and that their risk of cirrhosis-related complications (including HCC) is reduced, also in case of cirrhosis. Recent population-based studies extended these observations for solid extrahepatic outcomes, such as end-stage renal failure and cardiovascular events. Most importantly, SVR has been associated with prolonged overall survival. These results highlight the importance of the development of new direct-acting antivirals (DAAs), by which almost all patients are able to eradicate HCV in a comfortable manner. Based on the excellent first experiences with the DAAs, physicians gained confidence to use these drugs among patients with decompensated cirrhosis on a more regular basis as well. This was not possible with interferon therapy. Also in this high risk population the DAAs show high SVR rates with improvements in biochemical parameters of liver function shortly after therapy, especially in case of SVR. In fact, some patients could actually be removed from the liver transplantation waiting list due to clinical improvement following DAA therapy. How these short-term results translate into a prolonged (long-term) survival has yet to be determined, as well as which patients with decompensated liver disease are likely or not to benefit from viral eradication. Here we review the current data regarding the beneficial clinical outcome with antiviral therapy as well the remaining uncertainties in this field, both for patients with compensated liver disease and patients with decompensated liver disease.

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“…Fibrosis regression has been shown to decrease the risk of cirrhosis and hepatocellular carcinoma and mortality. 27,28 This study shows improvement in major laboratory parameters viz; AST, ALT, INR, AFP, platelets, albumin, bilirubin, creatinine. We found significant improvement in platelets count, forty three percent of patients with platelet count below normal limit at baseline had values in normal range at end of treatment, which is in accordance with previous studies.…”

Section: Discussionmentioning

confidence: 70%

Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosis

Awan

Saeed²,

Usmanghani³

et al. 2019

Asian J Med Sci

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Background: Cirrhosis is the late, symptomatic stage of chronic liver disease which occurs when scar tissue (fibrosis) largely replaces healthy liver tissue, compromising the function of the organ and predisposing to liver failure and hepatocellular carcinoma. It is mainly caused by hepatitis B and C virus infections or prolonged excessive consumption of alcohol. Aims and Objective: To study the therapeutic effects of Silybum marianum on liver fibrosis and cirrhosis in patients with chronic hepatitis C virus infection with Child Pugh Stage A& B. Materials and Methods: In this study 119 patients were treated for 6 months with Silybum marianum, their Liver stiffness measurements were carried out through Fibroscan, which is a non-invasive technique to assess liver fibrosis. Liver Fibrosis Scores viz; Aspartate aminotransferase/platelet ratio index(APRI) and fibrosis index based on four factors(FIB-4) were also employed at baseline and end of treatment. Results: Pre-treatment Liver Stiffness Measurement (LSM) score was 22.54 kilopascals(kPa) and post treatment was 17.30 kPa, a statistically significant change of 5.24 kPa (P ˂ 0.01) was observed, the mean percent change was 23.24%, its impact was observed in all METAVIR stages. Of the 72 (60.5%) patients with LSM ≥ 12.5 kPa (cirrhosis) at baseline 23 (32%) proved to have no cirrhosis (≥ 1 decrease in fibrosis stage) at post treatment. Similarly, 19 patients moved to stage F0-F1, 28 patients in F2 and 23 in F3. Overall fibrosis stage was improved (≥ 1 decrease in fibrosis stage) in 46 (38.7%) of 119 patients after 6 months of treatment. Serum fibrosis scores APRI and FIB-4 significantly decreased in comparison to baseline values. APRI values drooped from 1.24 to 0.83. FIB-4 score changed from 3.90 to 2.10. Conclusion: Our result suggests significant improvement with Silybum marianum in the patients status of liver fibrosis and cirrhosis associated with hepatitis C related chronic liver disease. Silybum marianum shows therapeutic effect in real life setting on the entire aspect of disease, as evaluated with the fibroscan and serum fibrosis score.

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Fibrosis Regression Explains Differences in Outcome in HIV-/HCV-Coinfected Patients with Cirrhosis After Sustained Virological Response

Abstract: Fibrosis regression after SVR is associated with the highest reduction in death of any cause, liver-related mortality, and liver-related complications in HIV-/HCV-coinfected patients with cirrhosis.

Cited by 15 publications

References 33 publications

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus

Reversion of disease manifestations after HCV eradication

Therapeutic effects of Silybum marianum in the treatment of liver fibrosis and cirrhosis

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