Impact of hepatitis C virus genotype-4 eradication following direct acting antivirals on liver stiffness measurement

Abstract

BackgroundLiver fibrosis is the most important prognostic factor in chronic hepatitis C virus (HCV) patients, and Egypt shows the highest worldwide HCV prevalence with genotype-4 pre-dominance. The aim of this study was to investigate the degree of liver stiffness measurement (LSM) improvement after successful HCV eradication.Patients and methodsThe study included 84 chronic HCV Egyptian patients, and was conducted at Qena University Hospital from November 1, 2015 till October 31, 2016. LSM was obtained by FibroScan® before starting direct acting antiviral (DAA) treatment and after achieving sustained virologic response-24 (SVR-24). Based on baseline LSM, patients were stratified into F0–F1, F2, F3 and F4 groups (METAVIR). LSM and laboratory data after achieving SVR-24 was compared with that before starting therapy in each fibrosis group (F0-F4), p-value <0.05 was statistically significant.ResultsFollowing DAA treatment, 80 patients achieved SVR-24; of these, 50 were males (62.5%), mean age: 54.2±7.6 years, and mean body mass index: 28.6±2.2 kg/m2. Mean baseline LSM dropped from 15.6±10.8 to 12.1±8.7 kPa post-SVR; the maximum change of −5.8 occurred in F4 versus −2.79, −1.28 and +0.08 in F3, F2 and F0–F1 respectively (p<0.0001). At baseline, 41 patients were in the F4 group; only 16 (39%) regressed to non-cirrhotic range (<12.5 kPa), while 25 (61%) were still cirrhotic despite achieving SVR-24 (p<0.0001). Patients who achieved LSM improvement (n=64) have had significantly higher baseline aspartate transferase (AST) and alanine transaminase (ALT). Also, those patients showed significant improvement in AST, AST/platelets ratio index (APRI) and fibrosis-4 index (Fib-4) after achieving SVR; 91% showed AST improvement (p=0.01) and APRI improvement (p=0.01) and 81% showed Fib-4 improvement (p=0.04). Females, diabetics, patients with S3 steatosis and patients older than 50 years showed less LSM improvements than their counterparts. Baseline LSM ≥9 kPa, bilirubin ≥1 mg/dl, ALT ≥36 U/L and AST ≥31 U/L were significant predictors for LSM improvement.ConclusionSuccessful HCV genotype-4 eradication results in significant LSM improvement; the best improvement occurs in F4 patients. But as the majority of cirrhotics are still at risk for liver decompensation and hepatocellular carcinoma development despite achieving SVR-24, early detection and treatment are highly recommended.

Liver stiffness measurement and spleen diameter as predictors for the presence of esophageal varices in chronic hepatitis C patients

“…In addition, there were no statistically significant differences regarding age and BMI between groups A and B. As genotype 4 is the most prevalent HCV genotype in Egypt [ 30 – 32 ] and TE is disease specific with different HCV genotypes can generate different elastographic cutoff readings, [ 33 – 35 ] our study was limited to genotype 4 while patients with other liver diseases such as chronic HBV, HCC, alcoholic, and autoimmune hepatitis were excluded. Also, schistosomiasis was excluded based on history, antischistosomal antibody negativity, and the absence of significant periportal fibrosis in ultrasound examination.…”

“…Also, despite TE was accurate for detecting clinically significant PHT with a mean area under the receiver-operating curve (AUROC) of 0.93 in a recent meta-analysis, [ 51 ] it has certain limitations in ascetic and obese patients. [ 35 ] Furthermore, most of available data about its use in PHT detection have been obtained in patients with untreated viral cirrhosis and alcoholic cirrhosis, whereas data regarding other etiologies and data in patients who have eliminated HCV require further investigation. [ 22 ] However, newer methods like point shear-wave elastography, 2-dimensional real-time shear-wave elastography, and magnetic resonance elastography show promising results [ 47 , 52 – 55 ] and could represent future research points.…”

Liver stiffness in chronic hepatitis C virus infection

“…The decrease of liver stiffness was more important in a group of patients with higher baseline levels of bilirubin (≥1 mg/dL), alanine aminotransferase, aspartate aminotransferase, and liver stiffness (≥ 9 kPa). The regression to non-cirrhotic stage of liver fibrosis was obtained in 39% of 80 Egyptian patients (where genotype-4 has the highest prevalence) [59].…”

Non-Alcoholic Fatty Liver Disease as a Coronary Heart Disease Severity Predictor

“…The procedure was performed after 8-hour fasting while the patient in the supine position. Result was not considered reliable except after acquisition of 12 successful readings with interquartile range/median ratio less than 30% [10]. LSM was used to estimate the METAVIR fibrosis stage as follows: F0-F1: 2.5 -6.9 kPa; F2: 7.0 -9.4 kPa; F3: 9.5 -12.4 kPa; F4: ≥ 12.5 kPa [11].…”