Improvement in hepatitis C virus patients with advanced, compensated liver disease after sustained virological response to direct acting antivirals

Edoardo G. Giannini, Mattia Crespi, Mariagiulia Demarzo, Giorgia Bodini, Manuele Furnari, Elisa Marabotto, Francesco Torre, Patrizia Zentilin, Vincenzo Savarino

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The outcome of patients with chronic hepatitis C virus infection (HCV) and advanced, compensated liver disease after sustained virological response (SVR) to direct-acting antivirals (DAAs) has not yet been completely depicted. We aimed to assess the clinical, biochemical and instrumental outcome of patients with advanced, compensated chronic HCV-related liver disease with DAA-induced SVR to DAAs and who had at least 1-year follow-up. Materials and methods: Fifty-two patients with cirrhosis (n = 27) and fibrosis stage F3 (n = 25) followed up for a median of 60 weeks after successful DAA treatment were included. Laboratory work-up, including APRI and FIB-4 scores, liver transient elastography and measurement of the spleen bi-polar diameter were carried out before treatment and at the end of follow-up. Results: Liver stiffness decreased (P < 0.0001) from a median baseline of 15.2 kPa (12.0-20.0) to 9.3 kPa (7.5-12.0) at follow-up. A liver stiffness value suggestive of the presence (ie, ≥21.0 kPa) of clinically significant portal hypertension was found in 13 patients (25.0%) at baseline and in seven patients (13.5%) at follow-up (P = 0.037). Both APRI (P < 0.0001) and FIB-4 score (P = 0.025) progressively decreased, while platelet count increased (143 × 10 9 /L [117-176] to 153 × 10 9 /L [139-186], P = 0.003), and spleen bi-polar diameter decreased (120 mm [112-123] to 110 mm [102-116], P = 0.0009) from baseline to the end of follow-up. Conclusions: In patients advanced, compensated chronic liver disease, liver stiffness significantly improves in the long-term after SVR, and this improvement is accompanied by an amelioration of indirect indices of liver fibrosis and function, and by a decrease in parameters of portal hypertension.

Original languageEnglish
Article numbere13056
JournalEuropean Journal of Clinical Investigation
Volume49
Issue number3
DOIs
Publication statusPublished - Mar 1 2019

Keywords

  • cirrhosis
  • fibrosis
  • hepatocellular carcinoma
  • outcome
  • portal hypertension
  • prognosis
  • spleen

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry

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