Permanent Liver Damage May Be Avoided with Early Hepatitis C Treatment

Liver stiffness drops through sustained virological response at 24 weeks with hepatitis C antiviral drug regimen.

In a study published in PLOS One, hepatitis C virus (HCV) patients saw a decrease in liver stiffness (LS) from pre-treatment to sustained virological response at 24 weeks (SVR24), and no significant decrease during the additional follow-up.

The primary goal of HCV treatment is to achieve SVR, halt liver damage progression, and establish conditions that may allow hepatic fibrosis to regress. Successful treatments are able to reduce fibrosis and liver-related mortality, and most studies have shown that curing HCV diminishes HCC risk.

However, a recent study found that while fibrosis regresses in most patients post-SVR, the repair is frequently incomplete, and cirrhosis will persist in approximately 40% of patients who had cirrhosis before having treatment.

In the current study, researchers conducted an observational study determine the impact of SVR to HCV treatment on LS. There were 100 patients with chronic HCV infection who achieved an SVR24, and had underwent FibroScan before and after treatment at the Mount Sinai Medical Center between 2008 and 2016.

Patients were excluded if they had an HIV co-infection, did not achieve SVR24, or who received a liver transplant. Medical record data was obtained on FibroScan measurements, body mass index (BMI), hemoglobin (Hb), international normalized ration (INR), platelet count, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), ɣ-glutamyl-transpeptidase (GGT), total bilirubin, and alpha fetoprotein (AFP) prior to treatment, and after achieving SVR24.

The antiviral regimens used to treat patients were categorized as interferon (IFN)-containing and IFN-free.

Researchers analyzed the data using 2-tailed paired t-tests, called the Mann-Whitney Wilcoxon Signed-rank tests, Fisher’s exact test, and linear regression. Furthermore, 2 time intervals used for investigations were: pre-treatment to SVR24 and SVR24 to end of follow-up.

Cirrhosis was defined as an LS score of ≥ 12.5 kPa, and a p-value below 0.05 was considered statistically significant. There were 100 patients analyzed for LS, with a median age of 60-years-old.

Seventy-two percent of patients were male, 60% were Caucasian, and 42% had cirrhosis pre-treatment. The median pre-treatment and SVR24 LS scores were 10.40 kPa (IQR: 7.25—18.60) and 7.60 kPa (IQR: 5.60–12.36), a statistically significant change of -2.15 kPa (IQR: -6.68 –-0.3), p<0.01.

Of the 42 patients with LS-defined cirrhosis pre-treatment, 60% of patients (25 people) still had LS scores ≥ 12.5 kPa at SVR24, indicating cirrhosis’ persistence. The median change in LS was found to be similar among patients who received IFN-containing and IFN-free regimens: -1.95 kPa (IQR: -5.75 —-0.38) versus -2.40 kPa (IQR: -7.70 –-0.23), p = 0.74.

Furthermore, in 56 patients with a post-SVR24 LS measurement, the LS scored changed by an additional -0.09 kPA (IQR: -2.98-0.5) during a median follow-up of 1.17 (IQR: 0.88-1.63) years. This was found to not be a statistically significantly decrease (p = 0.99).

The results of the study showed that compared with pre-treatment values, the SVR24 LS scores were significantly reduced. However, 66% of patients had SVR24 LS scores indicating ≥ F2 fibrosis and cirrhosis persisted in about 60% of patients who had cirrhosis pre-treatment.

During the post-SVR24 follow-up period that was more than 1 year in duration, researchers found that LS changed only minimally. Authors noted that in order to fully understand the impact of SVR on fibrosis stage and regression, histological validation and increased follow-up times are needed.