Sustained Virological Response by Direct Antiviral Agents in HCV Leads to an Early and Significant Improvement of Liver Fibrosis

Abstract

BACKGROUND:\ud Direct Antiviral Agents (DAA) demonstrated high efficacy among HCV-infected patients in registered trials. Nevertheless, the impact of these therapies on liver stiffness measurement(LSM) and liver functionality in "real-life" is not well-known. Aim of the present study was to evaluate the SVR impact on LSM and clinical parameters of DAA-therapy on a real-life population of HCV patients with F3/F4 fibrosis.\ud METHODS:\ud 749 HCV genotype 1-4 patients with F3/F4 hepatitis undergoing antiviral therapy, were consecutively enrolled in four centers of Hepatology of Italy. Clinical, biochemical and imaging data were collected at the baseline(T0), at the End of Therapy(EoT) and after 12 weeks(SVR12).\ud RESULTS:\ud Out of 749 patients, 69.7% was F4 and 30.3% was F3. SVR12 was reached in 97,5%. LSM significantly decreased from T0 to EoT(p<0.001) whereas it did not from EoT to SVR12(p:ns). Moreover, in F4 no significant differences were found in Child and MELD between T0, EoT and SVR12(p=ns). At the univariate analysis of clinical and liver parameters, baseline high glucose(p<0.005), type 2 diabetes(p<0.001), low ALT(p<0.001), low PLTs(p<0.005), and the presence of esophageal varices (EV)(p<0.001) were found to be associated with a lack of a significant EoT LSM improvement. At a multiple regression, ALT(p<0.05), Diabetes(p<0.005) and EV(p<0.05), were inversely associated with significant LSM reduction.\ud CONCLUSIONS:\ud Virological response to DAA is associated with fibrosis regression and recovery of liver functionality and this can be detected as early as EoT. HCV eradication is associated with a rapid and significant clinical improvement that lasts overtime and seems to be negatively influenced by diabetes and E

The prognostic factors between different viral etiologies among advanced hepatocellular carcinoma patients receiving sorafenib treatment

“…The reason might be due to the improving liver function after eradication of HCV. As previous studies, eradication of HCV helped improving the liver function and also the fibrosis regression . Furthermore, our results reflected the indication of antiviral therapy, wherein the HCV antiviral therapy was not suggested due to the limited life…”

Liver stiffness reduction and serum fibrosis score improvement in HIV/hepatitis C virus‐coinfected patients treated with direct‐acting antivirals

“…absence of sofosbuvir‐based DAA treatment, and duration of DAA treatment). The association of SVR with stiffness reduction found in HCV‐monoinfected patients was not confirmed in our study, probably because of the limited population size and small number of treatment failures.…”

“…In our study, in the univariate analysis, the change in liver stiffness was significantly associated with the following: patient characteristics (age), hepatic disease (HCV genotype, presence vs. absence of cirrhosis, and pre-DAA liver stiffness) and HCV treatment (presence vs. absence of previous interferon therapy, presence vs. absence of sofosbuvir-based DAA treatment, and duration of DAA treatment). The association of SVR with stiffness reduction found in HCV-monoinfected patients [5,8,9] was not confirmed in our study, probably because of the limited population size and small number of treatment failures.…”

“…With regard to liver disease after HCV treatment, a favourable effect on liver fibrosis or stiffness and on serum biomarkers has been widely documented, especially when an SVR is achieved [4][5][6][7][8][9][10][11][12][13]. Most studies investigated these dynamics in the HCV-monoinfected population or in patients treated with interferon plus ribavirin or first-generation DAAs.…”

Baseline risk factors determine lack of biochemical response after SVR in chronic hepatitis C patients treated with DAAs

“…The introduction of direct acting anti‐virals (DAA) as the standard therapy for chronic hepatitis C has fundamentally changed the treatment landscape leading to high viral cure rates in almost all patient populations affected by hepatitis C . Successful HCV eradication, as determined by sustained virological response (SVR) after DAA therapy, reduces patients’ risks for cirrhosis, diminishes extrahepatic manifestations and is associated with fibrosis regression and recovery of liver functionality, prompting the universal recommendation to treat all HCV‐infected patients, regardless of their degree of liver inflammation or fibrosis . However, viral cure from hepatitis C is not synonymous with resolution of liver disease.…”