title: Fibrosis evaluation by transient elastography in patients with long-term sustained HCV clearance.
abstract: BACKGROUND
  Reversibility of advanced fibrosis after HCV-clearance is an important goal of therapy.
  
  
  OBJECTIVE
  Measuring liver stiffness (LS) by transient elastography (TE) might be helpful in this setting.
  
  
  METHODS
  We evaluated 104 patients with biopsy-proven chronic hepatitis C (CHC) and sustained virological response (SVR) after Peg-Interferon (IFN) plus ribavirin since at least 18 months. HCV-eradication was confirmed searching for serum HCV-RNA (TMA® sensitivity > 5-10 IU/ml). Data from literature reported the best LS cut-off values for different stages of liver fibrosis were 7.1 kPa for Metavir stage 2 (F2), 9.5 kPa for F3 and 12.5 for cirrhosis (F4).
  
  
  RESULTS
  TE was not reliable in four SVR obese patients. Metavir-stage of biopsy was F0-1 in 28, F2 in 47, F3 in 17 and F4 in eight patients. The median interval elapsed since achieving SVR was 36 months (range: 18-77, SD¬¬:18). Stratifying patients according to the histological stage assessed before treatment, a clear-cut gradient of LS values was observed from F0-1: median: 3.8 kPa (range: 3.5-4.9) to F2: 4.6 kPa (3.8-6.0), F3: 6.2 kPa (4.8-8.6) and F4: 8.4 kPa (6.2-9.2) (P = 0.001). Overall, 86 patients had lower values of LS than the expected LS values according to Metavir-stage. At multivariate logistic analysis γ-GT and histological steatosis were independently associated with persistence of higher values of LS.
  
  
  CONCLUSIONS
  Long term responders to IFN-based therapies have lower LS values than those who are untreated and still viraemic. High levels of γ-GT and liver steatosis, all markers of insulin resistance, may hamper reduction of liver stiffness after HCV-clearance.
authors: Gastroenterologia and Epatologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy.
authors: Vincenza
authors: V
authors: Calvaruso
authors: Vito
authors: V
authors: Di Marco
authors: Donatella
authors: D
authors: Ferraro
authors: Salvatore
authors: S
authors: Petta
authors: Anna
authors: A
authors: Calì
authors: Maria
authors: M
authors: Grazia Bavetta
authors: Elisabetta
authors: E
authors: Conte
authors: Piero
authors: P
authors: Luigi Almasio
keywords: Elasticity Imaging Techniques; Insulin Resistance; Liver Cirrhosis
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