Effect of direct antivirals on liver fibrosis in patients with persistently virologically responsive chronic hepatitis C

Abstract

Abstract: Objective To investigate the effect of direct antiviral agents (DAAs) therapy on the improvement of liver fibrosis status in patients with chronic hepatitis C (CHC).Methods From January 2018 to December 2021, 104 patients (65 males and 39 female) with CHC were selected, including, aged (45.6±11.2) years. CHC diagnosis met the criterion and sustained virological response (SVR) was obtained. The changes of indexes of CHC patients before and after DAAs treatment were compared, and they were divided into chronic hepatitis, compensated cirrhosis and decompensated cirrhosis according to their liver disease status, and the changes of liver fibrosis indexes before and after treatment of three CHC liver diseases were compared. Logistic binary regression analysis was performed for univariate and multivariate analysis.Results The white blood cell (WBC), platelet (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) of CHC patients before DAAs treatment were (5.0±1.2) × 10⁹/L, (142.6±36.6) × 10⁹/L, (62.0±13.7) U/L, (52.8±11.3) U/L and (21.5±5.2) μmol/L, which were significant from those after treatment [(5.3±1.5) × 10⁹/L, (171.4±41.3) ×10⁹/L, (18.2±3.8) U/L, (21.6±4.1) U/L and (16.1±4.7) μmol/L], (P<0.05). The aspartate aminotransferase/platelet ratio index (APRI), fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) of CHC patients before DAAs treatment were (1.2±0.4), (3.0±1.0) and (11.6±3.7) kPa, which were significantly higher than those after DAAS treatment [(0.4±0.1), (1.7±0.7) and (7.3 ±2.0) kPa, P < 0.05]. According to the medical history, examination indexes and imaging data, CHC patients were divided into chronic hepatitis (n=67), compensated cirrhosis (n=22) and decompensated cirrhosis (n=15). The changes of APRI and FIB-4 in chronic hepatitis, compensated cirrhosis and decompensated cirrhosis before and after treatment were (-0.4±0.1), (-1.4±0.5) and (-1.9±0.9); (-0.4±0.2), (-2.2±0.8) and (-4.0±1.7), and the differences were statistically significant (P<0.05). In addition, before and after treatment, the changes of LSM in the three groups were (-2.3±1.0) kPa, (-4.6±1.5) kPa and (-9.5±3.8) kPa, and the difference was statistically significant (P<0.05). Combined with information from previous literature, a >30% reduction in LSM test values in patients with chronic liver disease after treatment compared to pre-treatment was defined as LSM improvement. Taking whether LSM of CHC patients improved after DAAs treatment as the dependent variable (assignment 0 = no improvement, 1 = improvement), the indexes before treatment were analyzed by univariate analysis, and the results showed that ALT, AST and APRI before treatment were related to LSM improvement. Further multivariate analysis showed that ALT and AST before treatment were independent influencing factors of LSM improvement.Conclusion DAAs can effectively improve the degree of liver fibrosis in patients with CHC. Once HCV infection is diagnosed, anti-HCV treatment should be started as soon as possible to prevent the progression of the disease.

Key words: Chronic hepatitis C, Direct acting antivirals , Sustained virological response, Hepatic fibrosis

YAN Jing-quan, LIU Juan, LU Xue-lan, LAN Yun-cui, LIN Zhan-zhou. Effect of direct antivirals on liver fibrosis in patients with persistently virologically responsive chronic hepatitis C[J]. Chinese Hepatolgy, 2023, 28(5): 530-533.

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