Liver Fibrosis Regression After Direct-Acting Antivirals For Hepatitis C Virus: A Prospective Study

Fahmy H Hablass, Sameh A. Lashen, Eman A. Alsayed


The impact of hepatitis C virus (HCV) elimination on liver fibrosis has been a hot topic since the introduction of direct-acting antivirals (DAAs). Liver stiffness (LS) can be evaluated non-invasively by transient elastography (TE). We aimed at evaluation of liver stiffness changes by FIB-4 and TE after HCV clearance. Patients and methods: prospectively, 137 patients were included (per-protocol analysis). Baseline liver test profile, LS by TE, and FIB-4 were done. Sustained virologic response was evaluated at 12 weeks after DAAs treatment (SVR12). LS and liver test profiles were re-evaluated after 12 months of follow-up. Results: An SVR12 was achieved among 97.3% of patients. In all patients, the FIB-4 and TE values after HCV elimination was significantly lower than its mean values at baseline (2.20±1.30 vs 3.76±2.23, and 8.32±3.16 v 11.75±5.47 kPa, P < 0.001 respectively). For patients with ≥ F2, 69.6% have fibrosis regression while cirrhosis regressed among 56.1% of patients with F4 at baseline. LS of 17.6 kPa could identify patients with a higher possibility of fibrosis regression (sensitivity= 94.4%, specificity= 82.6%, area under the curve = 0.88, p < 0.001). Fibrosis regression was associated with improvement in aminotransferases, serum albumin, bilirubin, and INR. Gender, age, platelet count, serum bilirubin, Child-Turcotte-Pugh score, and baseline fibrosis stage were the independent predictors for fibrosis regression. Conclusion: Achieving an SVR after DAAs therapy is associated with regression of fibrosis. Baseline clinicolaboratory parameters could predict the likelihood of fibrosis regression with an LS of 17.6 kPa is a suggested cut-off value


Liver stiffness; Transient Elastography; Direct-antivirals; FIB-4; Fibrosis


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