Changes in hepatic fibrosis stages after achieving SVR following direct‐acting anti‐viral treatment: a prospective study

Abstract

Summary Introduction Chronic hepatitis C (CHC) represents a major global health problem. The availability of direct‐acting anti‐virals (DAAs) allowed the treatment of many patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3). The impact of viral clearance following DAAs treatment on the natural history of liver cirrhosis is uncertain or not clearly evident in the literature as most studies were retrospective, including small number of patients and for short follow‐up duration; there is a need for a long follow‐up, large prospective study evaluating the changes in hepatic fibrosis after achieving sustained virological response (SVR) in cirrhotics. Patients and methods This is a prospective study including CHC patients with liver cirrhosis or advanced hepatic fibrosis who achieved SVR following DAAs from January 2015 until August 2017. Patients were followed up every 4‐6 months for at least 1 year from end of treatment. Staging of liver fibrosis was done using transient elastography and non‐invasive scores (FIB‐4, FIB‐5 and APRI). Results A total of 2326 CHC patients who achieved SVR were included. Follow‐up period was 23.51 ± 8.21 months (range 12‐45). In cirrhotic patients, 21.8% showed reversal of cirrhosis, 27.4% showed fibrosis regression while 50.8% remained stationary. About 26.5% of F3 patients showed reversal of fibrosis , 31.5% showed fibrosis regression and 30.6% remained stationary while 11.4% progressed to F4. Conclusion HCV clearance following DAAs treatment in CHC patients with liver cirrhosis or advanced hepatic fibrosis is associated with reversal of cirrhosis and regression of hepatic fibrosis in about 50% of patients.

Development of a simple dynamic algorithm for individualized hepatocellular carcinoma risk‐based surveillance using pre‐ and post‐treatment general evaluation score

“…Furthermore, the level of fibrosis and cirrhosis can change with the initiation of treatment and virus eradication. 20 Hence, our study suggests that an alternative, and potentially more efficient and cost-effective approach is an individualized risk-based surveillance strategy. If our results are independently confirmed, such a strategy would involve two GES and remained high post-GES, will need intense surveillance program which is important for early detection of HCC, followed by an early treatment which could increase patients' survival.…”

Diabetes Mellitus Increases the Risk of Hepatocellular Carcinoma After Direct-Acting Antiviral Therapy: Systematic Review and Meta-Analysis

“…Metabolic risk factors, such as metabolic syndrome, obesity, or insulin resistance, may further increase the risk of HCC through the presence of low-grade chronic inflammation ( 48 ). Furthermore, T2DM contributes to fibrosis progression after DAA therapy, which is a risk of HCC ( 52 ).…”

Long-Term Impact of Hepatitis C Virus Eradication on Liver Stiffness in Egyptian Patients

“…An Egyptian study conducted by Shiha et al [ 32 ] showed the reversal of cirrhosis in 21.8% of F 4 patients over a follow-up of 2 years. These findings are close to what we found at 3 years, where cirrhosis has been reversed in 234 (25.2%) patients.…”