The metabolic, renal and hematological changes in chronic hepatitis C patients after receiving direct antiviral therapy to achieve rapid virological response

Abstract

Abstract: Objective To analyze the efficacy and safety of sofosbuvir/velpatasvir in the treatment of children and adolescent patients with chronic hepatitis C (CHC). Methods A retrospective analysis was conducted on the medical records of 153 children and adolescents with CHC admitted to the hospital from March 2022 to January 2024. They were divided into an observation group (n=78) and a control group (n=75) according to different treatment methods. The efficacy, changes in liver function and liver fibrosis indexes and occurrence of adverse reactions in the two groups were compared. Results The sustained virological response at 24 weeks (SVR24)(100.00% vs. 82.67%), end of treatment response (EOT)(100.00% vs. 84%) and early virological response rate (EVR)(92.31% vs. 81.33%) at the end of treatment were higher in the observation group than those in the control group (P<0.05). After treatment, the levels of liver function index[AST(26.10±2.29)U/L vs. (35.02±3.36)U/L; total bilirubin (10.09±1.75)μmol/L vs. (13.20±2.23)μmol/L;ALT(25.04±2.40)U/L vs. (34.21±3.32) U/L] in both groups were decreased (P<0.05), and the downward trend of the observation group is more obvious. (P<0.05). After intervention, the serum concentrations of type III procollagen N-terminal peptide (PC-Ⅲ)[(35.01±3.25) ng/mL vs. (42.38±4.46) ng/mL], hyaluronidase acid (HA)[(84.11±9.13) ng/mL vs. (95.26±11.08) ng/mL] and laminin (LN)[(44.02±4.19) ng/mL vs. (53.65±7.83) ng/mL] demonstrated significant declines in both cohorts, with the observation group showing greater suppression in the biomarkers′ levels (P<0.05). There was no difference in the total incidence of adverse reactions between the two groups (14.10% vs. 10.67%) (χ²=0.415,P=0.519). Conclusion Sofosbuvir/velpatasvir is effective in the treatment of CHC in children and adolescents. It can improve the liver function and alleviate the progression of liver fibrosis, and is safe and reliable.

Key words: Chronic hepatitis C, Direct-acting antivirals, Rapid virological response, Anaemia

Yang Juan, Zhu Xiaoyan. The metabolic, renal and hematological changes in chronic hepatitis C patients after receiving direct antiviral therapy to achieve rapid virological response[J]. Chinese Hepatolgy, 2026, 31(6): 808-811.

References

[1] Stasi C, Brillanti S. Liver stiffness evaluation in chronic hepatitis C patients with cirrhosis before and after direct-acting antivirals[J]. Microorganisms, 2024, 12(7): 1418.
[2] Ji F, Tran S, Ogawa E, et al. Real-world effectiveness and tolerability of interferon-free direct-acting antiviral for 15,849 patients with chronic hepatitis C: a multinational cohort study[J]. J Clin Transl Hepatol, 2024, 12(7): 646-658.
[3] Stoenescu A F, Popescu C P, Florescu S A, et al. The prevalence of depression and its potential link to liver fibrosis in patients diagnosed with chronic hepatitis C virus infection prior to the initiation of direct-acting antiviral treatment[J]. Cureus, 2024, 16(6): e62970.
[4] Park Y, Na S K, Yoon J H, et al. Prognosis following sustained virologic response in Korean chronic hepatitis C patients treated with sofosbuvir-based treatment: data from a multicenter prospective observational study up to 7 years[J]. Medicina (Kaunas), 2024, 60(7): 1132.
[5] Amjed S, Saleem H G M, Ullah S, et al. Impact of ITPA gene polymorphism for predicting anemia and treatment outcome in HCV infected patients taking sofosbuvir ribavirin therapy[J]. BMC Infect Dis, 2024, 24(1): 301.
[6] Kozuka R, Hai H, Teranishi Y, et al. Correlation between polymorphism in the inosine triphosphatase and the reductions in hemoglobin concentration and ribavirin dose during sofosbuvir and ribavirin therapy[J]. J Gastroenterol Hepatol, 2017, 32(8): 1495-1502.
[7] Flamm S, Lawitz E, Borg B, et al. Efficacy and safety of sofosbuvir/velpatasvir plus ribavirin in patients with hepatitis C virus-related decompensated cirrhosis[J]. Viruses, 2023, 15(10): 2026.
[8] Benetti F, de Araújo A, de Maman Júnior I, et al. Impact of sustained virologic response on glucose parameters among patients with chronic hepatitis C treated with direct-acting antivirals[J]. Arch Endocrinol Metab, 2024, 68:e220480.
[9] 梁静, 刘芳, 张亚萍, 等. 慢性丙型肝炎应用直接抗病毒药物治疗后血尿酸水平的变化[J]. 中华肝脏病杂志, 2022, 30(1): 30-37.
[10] 吕菲南, 徐亮, 李萍, 等. 直接抗病毒药物治疗慢性丙型肝炎肝硬化的回顾性分析[J]. 中华传染病杂志, 2021, 39(2): 86-91.
[11] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 中华传染病杂志, 2020, 38(1): 9-28.
[12] Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest[J]. Hepatology, 2007, 46(1): 32-36.
[13] Bachofner J A, Valli P V, Kröger A, et al. Direct antiviral agent treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers fibrosis-4 score and aspartate aminotransferase-platelet ratio index[J]. Liver Int, 2017, 37(3): 369-376.
[14] Huynh T, Zhang J, Hu K Q. Hepatitis C virus clearance by direct-acting antiviral results in rapid resolution of hepatocytic injury as indicated by both alanine aminotransferase and aspartate aminotransferase normalization[J]. J Clin Transl Hepatol, 2018, 6(3): 258-263.
[15] Hussein H A, Allam A S, Moaty A S A. Evaluation of glycated haemoglobin (HbA1c) level in type 2 diabetic chronic HCV non-cirrhotic treatment-naïve Egyptian patients eadicated with sofosbuvir plus daclatasvir[J]. Curr Diabetes Rev, 2020, 16(2): 165-170.
[16] Thi Thu P N, Hoang Van D, Ngo Thi Quynh M, et al. Metabolic, renal, and hematological changes in chronic hepatitis C patients achieving rapid virologic response after 12 weeks of direct-acting antiviral treatment: a prospective cohort study[J]. PLoS One, 2023, 18(9): e0290235.
[17] Molina-Cuadrado E, Mateo-Carrrasco H, Collado A, et al. Anaemia predictors in patients with chronic hepatitis C treated with ribavirin and direct-acting antiviral agents[J]. Eur J Hosp Pharm, 2018, 25(3): 132-137.
[18] Villani R, Romano A D, Sangineto M, et al. Direct-acting antivirals improve kidney function in diabetic patients with HCV infection and chronic kidney disease[J]. Intern Emerg Med, 2021, 16(5): 1239-1245.
[19] Poordad F, Hezode C, Trinh R, et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis[J]. N Engl J Med, 2014, 370(21): 1973-1982.