Dynamic of Transient Elastography after Direct-acting Antiviral Based-therapy in Chronic Hepatitis C Infection
Preeyamas Koonsiripaiboon, MD1, Supatsri Sethasine, MD1
Affiliation : 1 Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background: Chronic hepatitis C infection (CHC) is a leading cause of liver cancer. CHC treatment goal is sustained virological response (SVR) achievement. Direct-acting antiviral (DAA) therapy has been introduced as a standard treatment for CHC.
Objective: The present study was to assess the impact of CHC treatment using DAA-based therapy on non-invasive assessments of liver fibrosis, namely by transient elastography (TE) fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) scores. The secondary objective was to find factors that affected changes in dynamic liver stiffness.
Materials and Methods: A retrospective analysis of data collected from individuals aged 18 to 70 years who were diagnosed with CHC and treated with DAA-based regimens at the Gastroenterology and Liver unit of Vajira Hospital between 2020 and 2021. Patients’ attributes were documented in electronic medical E-phis. TE measurements, FIB-4 and APRI were conducted at baseline, 3 and 12 months after the end of (EOT) treatment.
Results: Cirrhosis was diagnosed in 55.3% of the individuals. Among individuals treated with CHC, eighty out of 85 (94.1%) achieved SVR. The majority of participants (95%) who attained SVR showed a notable reduction in liver stiffness. Median TE value decreased significantly from baseline [16.8 (9.2, 24.2)] kPa, 3 months after EOT [12.2 (7.0, 21.3)], and 12 months after EOT [10 (6.0, 18.0) kPa], respectively. A significant reduction in TE was achieved by more than half (56.47%) of the participants. Furthermore, a decrease of >30% in TE value was observed in onethird of individuals diagnosed with cirrhosis. Nevertheless, the presence of baseline cirrhosis or an APRI score >1.5 decreases the probability of experiencing a substantial reduction in TE. The odds ratios for cirrhosis and APRI were 0.13 (95% CI: 0.04 to 0.40, p<0.001) and 0.29 (95% CI: 0.10 to 0.84, p=0.023), respectively.
Conclusion: The one-year dynamic of liver stiffness reduction by transient elastography was demonstrated in the majority of individuals with chronic hepatitis C who achieved a sustained viral response, regardless of the presence of cirrhosis.
Received 13 March 2024 | Revised 13 June 2024 | Accepted 16 July 2024
Keywords : Aspartate aminotransferase-to-platelet ratio index; Chronic hepatitis C infection; Direct-acting antiviral-based therapy; Fibrosis-4 score; Liver stiffness; Transient elastography
