Changes in Liver Steatosis Using Controlled Attenuation Parameter among Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals Therapy Who Achieved Sustained Virological Response

Abstract

Chronic hepatitis C virus (HCV) infection induces hepatic steatosis due to viral and host factors. However, information regarding the effects of direct-acting antivirals (DAAs) therapy on liver steatosis and fibrosis is limited. Vibration-controlled transient elastography (VCTE) with a controlled attenuation parameter (CAP) represents a non-invasive method, which has been used in the last few years for the detection of hepatic steatosis and fibrosis before and at a sustained virological response at 12 weeks (SVR12). The aim of this study was to assess the modifications of liver steatosis and fibrosis in HCV-infected patients who achieved SVR12. Consecutive patients with chronic HCV infection that were treated with DAAs in a tertiary gastroenterology center from Romania were included. Demographics, laboratory data, and VCTE evaluation were recorded in all patients. Patients with previous hepatic decompensation and those who did not achieve SVR were excluded. Two hundred and eighty patients (67.1% females) who achieved SVR12 were included. Regarding the changes in biological parameters, including liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), reduced to normal levels at SVR12 compared to the baseline (28.72 ± 24.71 U/L vs. 40.72 ± 27.34 U/L for ALT, p < 0.013 and 27.21 ± 11.15 U/L vs. 33.35 ± 23.37 U/L for AST, p = 0.029). On the contrary, the levels of triglycerides increased significantly from the baseline to SVR12 (124.03 ± 113.49 mg/dL to 153.78 ± 94.53, p = 0.004). Regarding hepatic steatosis by CAP evaluation, at SVR12, 186 (66.4%) of the individuals had a CAP score of ≥248 dB/m, an increase of 4.6% from the baseline. After viral eradication with DAAs, we observed an increase in hepatic steatosis. Hence, a long-term follow-up is mandatory to identify HCV-infected patients with hepatic steatosis post-SVR and the risk factors for more severe outcomes.

Changes in Components of Metabolic Syndrome after Antiviral Eradication in Hepatitis C Virus Infection

“…The resolution of hepatic inflammation and the reversal of fibrosis are also likely contributing factors to the decrease in liver stiffness that occurs after viral eradication [ 32 ]. The results of our study suggest that mean LSM values had decreased after DAAs regimens, with an increasing CAP score, similar to another study of ours, which has been published recently [ 33 ]. Moreover, the high value of the CAP score at SVR post-evaluation is correlated with increasing BMI, WC, triglycerides, and total cholesterol levels.…”

Sex-specific changes in triglyceride profiles in liver cirrhosis and hepatitis C virus infection

“…Reports on the effect of DAA treatment on blood TGs are, however, contradictory. An increase in blood TGs was described in some studies [19][20][21], whereas other studies could not identify a change in TG levels by DAA therapy [3,22,23] or even observed a decline [24,25]. It was also reported that elimination of HCV led to a rise in serum TGs in HCV patients with fibrosis stages F0-F2 but not in those with advanced disease [21,26].…”

Long-Term Monitoring of Liver Fibrosis and Steatosis in Patients with Chronic Hepatitis C after Achieving a Sustained Virologic Response to Antiviral Therapy

“…В научной литературе данные о динамике стеатоза печени после достижения УВО противоречивы. Часть из них демонстрирует уменьшение САР ТМ по данным ТФ, в том числе и у пациентов с ЦП, через 12-24 недели после окончания терапии ПППД [32][33][34][35], другие, наоборот, прогрессию стеатоза печени [36][37][38]. В проведенном исследовании зарегистрирована высокая распространенность стеатоза печени как до начала ПВТ, так и при длительном мониторинге после достижения УВО.…”