Therapy with Oral Directly Acting Agents in Hepatitis C Infection Is Associated with Reduction in Fibrosis and Increase in Hepatic Steatosis on Transient Elastography

Gyanranjan Rout; Baibaswata Nayak; Arpan H Patel; Deepak Gunjan; Vishwajeet Singh; Saurabh Kedia; Shalimar

doi:10.1016/j.jceh.2018.06.009

Therapy with Oral Directly Acting Agents in Hepatitis C Infection Is Associated with Reduction in Fibrosis and Increase in Hepatic Steatosis on Transient Elastography

J Clin Exp Hepatol. 2019 Mar-Apr;9(2):207-214. doi: 10.1016/j.jceh.2018.06.009. Epub 2018 Jun 21.

Authors

Gyanranjan Rout¹, Baibaswata Nayak¹, Arpan H Patel², Deepak Gunjan¹, Vishwajeet Singh³, Saurabh Kedia¹, Shalimar¹

Affiliations

¹ Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
³ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background/aims: Direct-Acting Antivirals (DAAs) are now the standard of care for management of Chronic Hepatitis C (CHC) infection. The aim of this study was to evaluate change in Liver Stiffness Measurement (LSM) and Controlled Attenuation Parameter (CAP) by transient elastography (FibroScan®) after completion of DAA therapy.

Methods: LSM and CAP were measured serially (baseline pre-treatment, at 12 weeks post therapy, and one year after completion of therapy) in a prospective cohort of 372 CHC patients treated with DAAs. Patients with at least two FibroScan measurements were included.

Results: The mean age was 38.1 ± 12.6 years; 58.3% males. Cirrhosis as defined by biopsy or fibroscan measurement (≥12.5) kPa was found in 25.5%. On paired analysis (n = 317), LSM (IQR) decreased from a baseline value 7.1 (5.3-13.8) kPa to 6.2 (4.8-11.2) kPa 12 weeks post therapy with a median decline 0.7 (-0.6-2.6) kPa, P < 0.001. Similarly, on paired analysis (n = 160), LSM decreased from baseline 6.9 (5.1-12.7) kPa to 6.1 (4.8-9.4) kPa after one year of treatment with median decline 0.9 (-0.6-3.2) kPa, P < 0.001. In contrast, on paired analysis (n = 317), CAP increased from baseline of 213.0 (180.0-254.5) dB/m to 225.0 (190.0-269.0) dB/m at 12 weeks post therapy with median increase 7.0 (-23.5-45.5), P = 0.001. Similarly, on paired analysis (n = 160), CAP increased from baseline of 210.0 (180.3-260.8) dB/m to 234.0 (204.0-282.0) dB/m at one year post therapy with median increase 25.0 (-12.5-61.5) dB/m, P < 0.001. On multivariate linear regression analysis, low baseline CAP value and low albumin were significantly associated with increase in CAP values.

Conclusion: Treatment with DAAs reduces liver stiffness, but is associated with increase in hepatic steatosis.

Keywords: AASLD, American Association for the Study of Liver Diseases; ALT, Alanine Aminotransferase; AST, Aspartate Aminotransferase; BMI, Body Mass Index; CAP, Controlled Attenuation Parameter; CHC, Chronic Hepatitis C; DAAs, Directly-Acting Antivirals; F0-4, METAVIR Fibrosis Stage 0 to 4; Fibroscan; HCV, Hepatitis C Virus; HIV, Human Immunodeficiency Virus; IFN, Interferon; IQR, Interquartile Range; LSM, Liver Stiffness Measurement; NAFLD, Non-alcoholic Fatty Liver Disease; SD, Standard Deviation; SVR12; SVR12, Sustained Viral Response at 12 Weeks; TE, Transient Elastography; controlled attenuation parameter; liver stiffness measurement.