Changes in hepatic fibrosis and incidence of HCC following direct-acting antiviral treatment of F3 chronic hepatitis c patients: a prospective observational study

Shiha, Gamal; Soliman, Reham; Hassan, Ayman A.; Mikhail, Nabiel

doi:10.20517/2394-5079.2022.13

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…Liver fibrosis regression is an important variable to study as it has been shown to decrease complications, such as HCC, and the need for transplantation. Several studies reported a reduction in the rate of HCC following DAA treatment as a result of liver fibrosis regression [ 7 , 9 , 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The natural history of HCV infection is variable and depends on various factors; hepatic injury can range from minimal necroinflammatory changes to extensive liver fibrosis and cirrhosis development and increases the risk of hepatocellular carcinoma (HCC) development. The updated literature has shown improvements in liver fibrosis (LF) after treatment with DAAs [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, a decrease in HCC incidence was shown shortly after achieving a SVR in patients with advanced liver fibrosis [ 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

Abu-Freha,

Abu-Kosh,

Yardeni

et al. 2023

Life

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There is accumulating evidence that treatment of chronic hepatitis C (HCV) leads to improvements in liver fibrosis. We aimed to investigate the improvement in fibrosis stage following treatment with direct-acting antivirals (DAAs) and factors associated with fibrosis regression. Fibroscan® was performed for patients treated with DAAs, at least 3 years post-HCV eradication. The fibrosis stage at the onset of treatment was compared with the current fibrosis stage. A total of 209 patients were enrolled in this study (56% males; age 58.8 ± 13.3 years; age at treatment 54 ± 10.9 years). Genotype subgrouping was as follows: 1a (16%), 1b (58%), 2a (4%), 3 (18%), and 4a (2%). Overall, 71% of patients were considered treatment-naïve, with a mean follow-up time of 4.5 ± 1.3 years. Fibrosis improvement was observed among 57% of patients; fibrosis progression was seen among 7% of patients and no change was seen in 36% of patients. Moreover, 28% of these patients regressed from F3/F4 to F2 or less. In our multivariable analysis, the age at treatment and advanced fibrosis stage were found to be factors significantly associated with fibrosis regression. In conclusion, fibrosis improvement was observed among 57% of HCV patients after treatment with DAAs. Age and advanced fibrosis at baseline were found to be factors associated with fibrosis regression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

Abu-Freha,

Abu-Kosh,

Yardeni

et al. 2023

Life

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“…At 96 weeks after successful DAA treatment, 17% of patients had progressive hepatic fibrosis [ 9 ]. In another observational study, the progression of liver fibrosis occurred in 12.5% of patients achieving SVR post-DAA therapy [ 10 ]. Notably, the incidence rate of HCC was the highest among patients with fibrosis progression (6.17/100 patient-years) compared to patients with stable fibrosis (1.09/100 patient-years) and those with fibrosis regression (0.75/100 patient-years) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…In another observational study, the progression of liver fibrosis occurred in 12.5% of patients achieving SVR post-DAA therapy [ 10 ]. Notably, the incidence rate of HCC was the highest among patients with fibrosis progression (6.17/100 patient-years) compared to patients with stable fibrosis (1.09/100 patient-years) and those with fibrosis regression (0.75/100 patient-years) [ 10 ]. These findings supported an observation in a previous cohort study showing that patients with progressive liver fibrosis after SVR had a significantly higher rate of HCC development than those with fibrosis regression or stability (33% vs. 4% at 5 years, p < 0.001) [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Liver Stiffness and Liver-Related Events in HCV-Infected Patients after Successful Treatment with Direct-Acting Antivirals

et al. 2023

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Background and Objectives: Direct-acting antivirals (DAAs) are highly effective for the treatment of chronic hepatitis C virus (HCV) infection, but the risk of liver-related events and hepatocellular carcinoma (HCC) remains after successful therapy. We aimed to evaluate post-treatment changes in liver stiffness (LS) and identify a cut-off LS value for predicting such events in chronic HCV-infected patients receiving DAA. Materials and Methods: A total of 185 patients who had achieved sustained virologic response (SVR) after DAA therapy were included. Baseline characteristics and laboratory results were retrospectively abstracted. LS was measured by transient elastography at baseline, 12, 24, 48, and 96 weeks after SVR. FIB-4 index was assessed at baseline and 48 weeks after SVR. Development of liver-related events (hepatocellular carcinoma (HCC), portal-hypertension-related decompensation, listing for transplantation, and mortality) after SVR were identified. The association between liver fibrosis and the occurrence of liver-related events was analyzed using Cox regression analysis. Results: Significant differences in LS values were observed between baseline and 24, 48, 72, and 96 weeks after SVR. FIB-4 index at 48 weeks after SVR was significantly lower than the FIB-4 index at baseline. During the 41.6-month follow-up time, the incidence rates of all liver-related events and HCC were 2.36 and 1.17 per 100 person-years, respectively. Age, LS ≥8 kPa, and FIB-4 ≥1.35 at 48 weeks post-SVR were significantly associated with the occurrence of any liver-related events. By multivariate analysis, LS ≥8 kPa at 48 weeks post-SVR remained significantly associated with any liver-related events, with an adjusted hazard ratio (95%CI) of 5.04 (1.01–25.26), p = 0.049. Conclusions: Despite a significant reduction in LS after SVR, patients with LS ≥8 kPa at 48 weeks after SVR should be regularly monitored for liver-related complications, particularly HCC development.

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Individualized HCC surveillance using risk stratification scores in advanced fibrosis and cirrhotic HCV patients who achieved SVR: Prospective study

Shiha,

Hassan,

Mousa

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundSeveral HCC risk stratification scores were developed; however, none has been prospectively validated. The primary aim is to validate the clinical utility of six HCC risk scores in large prospective study of F3‐4 patients achieving SVR following DAAs according to EASL guidelines. The secondary aim is to explore whether individualized risk stratification improves detection of HCC at early stages amenable to curative treatment.MethodsThis prospective study included two cohorts: Egyptian Liver Research Institute and Hospital (ELRIAH) cohort of 463 chronic HCV patients with advanced liver disease (F3 and F4) achieved SVR with a follow‐up every 6 months according to EASL guidelines using 6 simple HCC risk scores and Tanta cohort of 492 comparable patients where individualized surveillance intervals were tailored based on HCC risk assessments using GES score as follows: low‐risk patients were followed yearly, intermediate‐risk every 6 months and high‐risk every 2–3 months.ResultsAll scores, except Watanabe post, successfully stratified patients into low‐, intermediate‐ and high‐risk groups, with log‐rank p‐value of 0.001 and Harrell's C ranging from 0.669 to 0.728. Clinical utility of these scores revealed that the highest percentage of patients classified as low risk was 42.5% using the GES, while the lowest was 8.9% using the aMAP. ELRIAH cohort, 25 patients developed HCC with 52% diagnosed at BCLC 0 and A. Tanta cohort, 35 patients developed HCC, with 80% diagnosed at BCLC 0 and A.ConclusionIndividualized risk stratification using HCC risk scores was associated with improved early‐stage detection and receipt of curative treatment.

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Changes in hepatic fibrosis and incidence of HCC following direct-acting antiviral treatment of F3 chronic hepatitis c patients: a prospective observational study

Cited by 6 publications

References 21 publications

Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

Liver Fibrosis Regression and Associated Factors in HCV Patients Treated with Direct-Acting Antiviral Agents

Association between Liver Stiffness and Liver-Related Events in HCV-Infected Patients after Successful Treatment with Direct-Acting Antivirals

Individualized HCC surveillance using risk stratification scores in advanced fibrosis and cirrhotic HCV patients who achieved SVR: Prospective study

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