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

Abstract

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.

Effect of HCV Core Antigen and RNA Clearance during Therapy with Direct Acting Antivirals on Hepatic Stiffness Measured with Shear Wave Elastography in Patients with Chronic Viral Hepatitis C

“…In our study we found that patients with advanced inflammation and ALT above 100 U/L had a statistically greater LS change between baseline and FU96, which is consistent with previous studies [40,47,48]. We also found, similarly to Chekuri et al, a positive correlation between the size of LS change and ALT activity between baseline and FU96 [35].…”

“…In our group of patients, we found improvement in albumin and ALT levels. However, the level of platelets did not change significantly, which is in contrast to some of the previous studies [35,40]. Probably due to the transient hyperbilirubinemia associated with the treatment (OMB/PRV/rtv ± DSV ± RBV), a statistically significant decrease in the level of bilirubin between baseline and FU24 and FU96 was observed.…”

“…This observation has already been made in earlier studies [35][36][37][38][39]. In our cohort, the range of changes in kPa was −4.2 to 41.8 kPa between baseline and FU24, 2.3 kPa to 29 kPa between baseline and FU96, and −2.6 to 18.7 between EOT and FU96.…”

“…In the previously mentioned Arima et al study and the Chekuri et al study, no further decrease in LS was observed after treatment in long-term follow-up-no change between in LS between 1 and 2 years of follow-up [35,37]. Conversely, in the Tada et al study, as mentioned above, an LS decrease was also observed 24 weeks after therapy completion [40].…”

“…In various studies, the results are ambiguous. Chekuri et al observed a statistically significant increase in BMI, while in the study by Patton et al there was no such relationship [35,49]. Chekuri et al as the reason for the increase in BMI suggested hypermetabolism related to reduction of HCV associated inflammation, but this finding requires further studies.…”