Liver Fibrosis Regression on Acoustic Radiation Force Impulse Elastography after Successful Direct-Acting Antiviral Therapy: 1-Year Follow-Up.

Ahmed Zeid, Mohamed El-Shafei, Mohamed Bakosh, Assem El-Shendidi


Aim: Acoustic radiation force impulse (ARFI) is an ultrasound elastography that delineates liver stiffness measurement (LSM) non-invasively. Data on the utility of ARFI in monitoring hepatic fibrosis evolution after hepatitis C virus (HCV) cure are still lacking. This study was designed to investigate the serial changes of ARFI-LSM and serum-based fibrosis scores in HCV-infected patients who achieved sustained virologic response (SVR) after direct-acting antivirals (DAAs) therapy.Material and Methods: This study included 174 treatment-naïve HCV-infected patients who achieved SVR after DAAs. ARFI was performed in addition to fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet count ratio index (APRI) scores for patients at baseline, end of therapy (EOT), 12, 24 and 48 weeks after EOT.Results: Serum aminotransferases declined significantly overtime till 12 weeks after the EOT. Platelet count showed continuous significant increase over the follow-up period. Both FIB-4 and APRI scores demonstrated a continuous significant decline between the baseline and 48 weeks after EOT, except the period between EOT and 12 weeks after EOT when there was no significant change observed in FIB-4. There was a continuous significant decline of ARFI-LSM from the baseline over the follow-up period. In non-cirrhotic patients, the higher baseline ARFI-LSM was an independent predictor of fibrosis regression at 48 weeks after EOT. Absent portal hypertension and compensated liver disease at baseline were associated with ARFI-LSM improvement at 48 weeks after EOT in cirrhotic patients.Conclusions: Continuous improvement in LSM after HCV eradication occurred due to resolution of liver injury and fibrosis regression. ARFI is a feasible and promising non-invasive method for hepatic fibrosis assessment.


Hepatitis C Virus; Fibrosis regression; Direct-acting antivirals; Acoustic radiation force impulse elastography; Liver stiffness.


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