Morphometry Confirms Fibrosis Regression From Sustained Virologic Response to Direct Acting Antivirals for Hepatitis C
Open Access
- 1 November 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology Communications
- Vol. 2 (11), 1320-1330
- https://doi.org/10.1002/hep4.1228
Abstract
Sustained virologic response (SVR) after direct-acting antiviral (DAA) therapy for chronic hepatitis C results in significant decreases in liver stiffness measured by transient elastography (TE). The aim of this study was to clarify if TE can guide post-SVR management in patients with advanced fibrosis or cirrhosis prior to treatment as current guidelines are unclear on the role of TE after SVR. In total, 84 patients with hepatitis C virus and advanced fibrosis or cirrhosis and from a single center underwent DAA treatment and achieved SVR. Overall, 62% had improved liver stiffness that was consistent with regression of at least one stage of fibrosis. In the cirrhosis group, 48% showed fibrosis regression by at least two stages by TE (<9.5 kPa). In the F3 fibrosis group, 39% regressed by at least two stages (<7 kPa). The median time from SVR to regression by TE was 1 year. Fifteen patients with liver biopsies prior to SVR underwent a biopsy after SVR; 13 of these patients had improved liver stiffness (to <9.5 kPa). The post-SVR liver biopsies of only 4 patients showed F1-F2 while 11 patients showed F3-F4; however, morphometry of the first 11 biopsied patients revealed that 10 patients had an average 46% decrease in collagen content. Conclusion: This is the first DAA study that also has paired liver biopsies showing fibrosis regression. After SVR is achieved, improvements in liver stiffness measured by TE are seen in a majority of patients with advanced fibrosis/ cirrhosis within 2 years. TE improvements are overstated when compared to histologic staging but confirmed with morphometric analysis. It is unclear whether TE following SVR can reliably predict when patients no longer require advanced fibrosis/cirrhosis monitoring after SVR.This publication has 25 references indexed in Scilit:
- The diagnostic accuracy of Fibroscan® for cirrhosis is influenced by liver morphometry in HCV patients with a sustained virological responseJournal of Hepatology, 2013
- Noninvasive Methods to Assess Liver Disease in Patients With Hepatitis B or CGastroenterology, 2012
- Levels of Alanine Aminotransferase Confound Use of Transient Elastography to Diagnose Fibrosis in Patients With Chronic Hepatitis C Virus InfectionClinical Gastroenterology and Hepatology, 2012
- Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracyJournal of Hepatology, 2010
- Aging of Hepatitis C Virus (HCV)-Infected Persons in the United States: A Multiple Cohort Model of HCV Prevalence and Disease ProgressionGastroenterology, 2010
- Brief Communication: The Relationship of Regression of Cirrhosis to Outcome in Chronic Hepatitis CAnnals of Internal Medicine, 2008
- Progression of fibrosis in advanced chronic hepatitis C: Evaluation by morphometric image analysisHepatology, 2007
- Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis CHepatology, 2004
- An algorithm for the grading of activity in chronic hepatitis CHepatology, 1996
- An Update on Terminology and ReportingThe American Journal of Surgical Pathology, 1995