Rapid decline of noninvasive fibrosis index values in patients with hepatitis C receiving treatment with direct-acting antiviral agents

Abstract

Background Studies on temporal changes in noninvasive fibrosis indices and liver stiffness measurement (LSM) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral agents (DAAs) are limited. Methods We retrospectively enrolled consecutive patients with CHC who had received DAAs. Results In total, we recruited 395 consecutive patients, of which 388 (98.2%) achieved a sustained virologic response (SVR) at 12 weeks after therapy. In patients who received DAA therapy and achieved SVR 12 weeks after therapy ( n = 388), the median aspartate aminotransferase/platelet ratio index (APRI) value decreased from 1.19 (0.62–2.44) at baseline to 0.50 (0.32–0.95), 0.51 (0.31–0.92), 0.48 (0.31–0.88), and 0.52 (0.33–0.92) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median FIB-4 value decreased from 2.88 (1.56–5.60) at baseline to 2.10 (1.30–3.65), 2.15 (1.30–3.65), 2.11 (1.37–3.76), and 2.22 (1.45–3.82) at week 2, week 4, end of therapy, and PW12, respectively (all P < 0.001). The median alanine aminotransferase level significantly decreased from week 2 until PW12 (all P < 0.001). The platelet count significantly increased from 2 weeks after DAA therapy initiation until PW12 (all P < 0.001); however, the magnitude of changes in the platelet count was low. In patients with paired LSMs obtained using acoustic radiation force impulse elastography at baseline and PW12 ( n = 199), the median LSM decreased from 1.78 (1.25–2.30) m/s at baseline to 1.38 (1.14–1.88) m/s at PW12 ( P < 0.001). Conclusions Noninvasive fibrosis indices, namely APRI and FIB-4, exhibited a rapid and sustained decline from week 2 until PW12 in patients with CHC who achieved SVR to DAA therapy. The rapid decline in APRI and FIB-4 values might mainly result from improvement in necroinflammation. Electronic supplementary material The online version of this article (10.1186/s12876-019-0973-5) contains supplementary material, which is available to authorized users.

Gender as a factor affecting the NK cell activity in patients successfully treated for chronic hepatitis C with DAA

“…After the successful DAA therapy, we observed a decrease in liver brosis as well as improvement in biochemical and haematological parameters comparable to the changes presented in the literature 33 . Interferon-free HCV therapies are doubtlessly a great achievement of modern medicine.…”

A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil

“…The low increase in the number of platelets in our study was possibly due to the absence of thrombocytopenia in our patients before starting the therapy with DAAs, as was also seen in the study by Omar et al 35 . Accordingly, in a study by Hsu et al 36 in non-transplanted patients with CHC treated with DAAs, an increase in the number of platelets was observed only in patients who presented with thrombocytopenia before the treatment 36 .…”

“…Indeed, Omar et al found a progressive improvement in the degree of liver fibrosis, as indicated by elastography and serum scores, 12 and 18 months after the treatment of CHC with DAAs in 52 liver transplant patients 35 . The regression APRI and FIB-4 scores after treatment of CHC with DAAs, in both liver transplant and non-transplant patients, can occur by reducing serum levels of liver enzymes or by increasing the number of platelets 36 . Classically, patients with CHC have elevated serum levels of liver enzymes, reflecting virus-induced damage to hepatocytes, and normalization occurring during and after treatment, because of HCV elimination 36 .…”

“…The regression APRI and FIB-4 scores after treatment of CHC with DAAs, in both liver transplant and non-transplant patients, can occur by reducing serum levels of liver enzymes or by increasing the number of platelets 36 . Classically, patients with CHC have elevated serum levels of liver enzymes, reflecting virus-induced damage to hepatocytes, and normalization occurring during and after treatment, because of HCV elimination 36 . In fact, in our study, this expected behaviour of serum levels of liver enzymes was observed, starting at week 4 after the beginning of DAA therapy, reflecting a reduction in the necroinflammatory activity in the liver parenchyma accompanying the elimination of HCV.…”

Response of human liver tissue to innate immune stimuli

“…Previous reports on the impact of liver fibrosis with DAA treatment relied on the indirect measurements with transient elastography and noninvasive fibrosis indices [22, 23]. We examined the liver fibrosis directly using picrosirius red and trichrome staining ( Fig.…”