TY - JOUR
T1 - Factors affecting long-term changes of liver stiffness in direct-acting anti-hepatitis C virus therapy
T2 - A multicentre prospective study
AU - Rosato, Valerio
AU - Ascione, Antonio
AU - Nevola, Riccardo
AU - Fracanzani, Anna Ludovica
AU - Piai, Guido
AU - Messina, Vincenzo
AU - Claar, Ernesto
AU - Coppola, Carmine
AU - Fontanella, Luca
AU - Lombardi, Rosa
AU - Staiano, Laura
AU - Valente, Giovanna
AU - Fascione, Maria Chiara
AU - Giorgione, Chiara
AU - Mazzocca, Annalisa
AU - Galiero, Raffaele
AU - Perillo, Pasquale
AU - Marrone, Aldo
AU - Sasso, Ferdinando Carlo
AU - Adinolfi, Luigi Elio
AU - Rinaldi, Luca
N1 - Publisher Copyright:
© 2021 John Wiley & Sons Ltd
PY - 2022
Y1 - 2022
N2 - The long-term changes of liver stiffness (LS) in patients who achieve viral clearance after direct-acting anti-HCV therapy remain undefined. We conducted a multicentre prospective study to investigate this aspect. Patients with HCV infection treated with DAAs were enrolled from six Italian centres; they underwent clinical, biochemical, ultrasound and transient elastography evaluations before treatment (T0), 12 weeks (SVR12) and 24 months (T24) after the end of therapy. Among the 516 consecutive patients enrolled, 301 had cirrhosis. LS significantly decreased from T0 to SVR (14.3 vs 11.1 kPa, p =.002), with a progressive reduction until T24 (8.7 kPa, p <.001). However, only patients with steatosis and those who developed HCC did not experience a late improvement in LS. Multivariate analysis of baseline and follow-up variables identified steatosis as the only independent predictor of failure of LS improvement (OR 1.802, p =.013). ROC curve analysis of the association of LS with the risk of developing HCC showed that SVR12 ≥14.0 kPa had the highest accuracy (sensitivity 82%, specificity 99%; AUC: 0.774). Multivariate analysis revealed that LS was the only variable independently associated with an increased risk of developing HCC (OR 6.470, p =.035). Achieving an SVR was associated with a progressive, long-term decline of LS, suggesting a late improvement in liver fibrosis, besides the resolution of inflammation. Fatty liver and the development of HCC interfered with late reduction of LS. Patients with an LS ≥14 kPa at 12 weeks after the end of treatment were at higher risk for developing HCC.
AB - The long-term changes of liver stiffness (LS) in patients who achieve viral clearance after direct-acting anti-HCV therapy remain undefined. We conducted a multicentre prospective study to investigate this aspect. Patients with HCV infection treated with DAAs were enrolled from six Italian centres; they underwent clinical, biochemical, ultrasound and transient elastography evaluations before treatment (T0), 12 weeks (SVR12) and 24 months (T24) after the end of therapy. Among the 516 consecutive patients enrolled, 301 had cirrhosis. LS significantly decreased from T0 to SVR (14.3 vs 11.1 kPa, p =.002), with a progressive reduction until T24 (8.7 kPa, p <.001). However, only patients with steatosis and those who developed HCC did not experience a late improvement in LS. Multivariate analysis of baseline and follow-up variables identified steatosis as the only independent predictor of failure of LS improvement (OR 1.802, p =.013). ROC curve analysis of the association of LS with the risk of developing HCC showed that SVR12 ≥14.0 kPa had the highest accuracy (sensitivity 82%, specificity 99%; AUC: 0.774). Multivariate analysis revealed that LS was the only variable independently associated with an increased risk of developing HCC (OR 6.470, p =.035). Achieving an SVR was associated with a progressive, long-term decline of LS, suggesting a late improvement in liver fibrosis, besides the resolution of inflammation. Fatty liver and the development of HCC interfered with late reduction of LS. Patients with an LS ≥14 kPa at 12 weeks after the end of treatment were at higher risk for developing HCC.
KW - antiviral treatment
KW - hepatitis C
KW - hepatocellular carcinoma
KW - liver stiffness
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U2 - 10.1111/jvh.13617
DO - 10.1111/jvh.13617
M3 - Article
AN - SCOPUS:85116884605
VL - 29
SP - 26
EP - 34
JO - Journal of Viral Hepatitis
JF - Journal of Viral Hepatitis
SN - 1352-0504
IS - 1
ER -