Letter: can persisting liver stiffness indicate increased risk of hepatocellular cell carcinoma after successful anti-HCV therapy? - authors’ reply

Impact of hepatitis C oral therapy in portal hypertension

“…Indeed, a more pronounced liver stiffness improvement was found between baseline and end of treatment than between end of treatment and 6 mo after, suggesting an important role of necroinflammation on the early improvements in liver stiffness[36]. Deterding et al[37] suggested a two-phasic decline of portal hypertension consisting of a first rapid phase during treatment (associated with improved inflammation) followed by a slower second phase after 6-12 mo (associated with fibrosis regression). This hypothesis will surely be tested and hopefully confirmed when longer follow-up results become available.…”

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“…Data in patients undergoing IFN-free antiviral therapies suggest that liver stiffness rapidly declines during treatment, even in patients with advanced fibrosis and cirrhosis. This decline appears to reflect the reduction in liver inflammation, restoration of liver function and the decrease in portal pressure, like an effect of HCV eradication [169,170].…”

“…In the largest prospective study published (n = 91), a significant liver stiffness decrease was observed during therapy with peg-interferon and ribavirin; the decrease in liver stiffness continued after treatment only in patients who achieved SVR [171]. In the era of DAAs, it is important to remark that after successful HCV eradication, the use of pre-treatment cut-off values can impair the accuracy of TE [172,173], and it might lead to erroneous conclusions if the SVR status is not carefully taken into account [170]. Several studies have evaluated the use of VTQ ® for monitoring IFN-based antiviral therapy in HCV patients: SWE decrease or increase reflects response or no response to treatment, respectively [174 -176].…”

Prevention of Hepatocellular Carcinoma

“…Nevertheless, also after an effective HCV infection treatment, HCC still develops in some of these patients, especially in the setting of cirrhosis, although it will occur with less likelihood (HR 0.25 in prospective studies) [27]. It is still not clear, however, how successfully anti-HCV therapy will impact on liver fibrosis in the long term and which parameters are useful to identify patients at risk to develop HCC even after HCV clearance [28,29]. Remarkably, fewer than 20% of infected patients receive treatment of HCV infection in the US and Europe, mostly because patients are not aware of the infection [5].…”