Background and AimFew studies have evaluated sustained virological response (SVR) rates by direct‐acting agents (DAAs) and liver stiffness measurement (LSM) changing post‐SVR in limited‐resource settings. We aimed to describe the effectiveness of DAAs for hepatitis C virus treatment and to assess the changing of LSM post‐SVR.MethodsThis retrospective study analyzed data of consecutive hepatitis C virus‐infected patients treated by DAAs from 2015 to 2017 in two tertiary centers in Brazil. SVR rates were reported by intention‐to‐treat and per‐protocol analyses. LSM by transient elastography performed before treatment and post‐SVR was compared, and logistic regression models were performed.ResultsSix hundred seventy‐one patients (63% female, 62 years [55–68], 89% genotype 1, 8% HIV co‐infected, and 64% with cirrhosis) were included. Most patients were treated by sofosbuvir/daclatasvir ± ribavirin (74%) and sofosbuvir/simeprevir ± ribavirin (21%). SVR rates (95% confidence interval [CI]) were 94.6% (92.7–96.1) and 97.8% (96.4–98.7) for intention‐to‐treat and per‐protocol analyses, respectively. The leading adverse event was anemia (9.6% [95% CI 7.6–12.1]). Pretreatment and post‐SVR12 LSM were available in 400 patients. LSM had significantly decreased after SVR (13.6 kPa [interquartile range, 10.0–21.6] vs 10.2 kPa [7.0–17.6], P < 0.001). A total of 167 patients (42%) decreased at least 30% of LSM post‐SVR. The absence of type 2 diabetes (odds ratio = 1.52 [95% CI 1.05–2.21], P = 0.028) and presence of platelet count ≥ 150 × 109/mm3 (odds ratio = 1.75 [1.23–2.50], P = 0.002) were independently associated with a significant LSM regression (≥ 30%) post‐SVR.ConclusionDAAs were highly effective and safe, and LSM significantly decreased after SVR in a real‐life cohort in Brazil. The absence of type 2 diabetes and presence of high platelet count were independently associated with LSM decrease post‐SVR.

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The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.

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