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.
Novel direct antiviral agents (DAA) targeting hepatitis C virus (HCV) have revolutionized the treatment of chronic hepatitis C infection (CHC). Rates of sustained virological response (SVR) to treatment have drastically improved since introduction of DAA. Transient Elastography (TE) is an ultrasound based, non-invasive technique to assess liver stiffness (LS). We examined the changes in TE values and fibrosis scores FIB-4 and APRI after DAA treatment of CHC.



549 patients who received a DAA based treatment for CHC were screened and 392 were included. TE values recorded prior to therapy and within 18 months after therapy were evaluated. In addition, FIB-4 and APRI scores were calculated and histopathological results were recorded if available.



Median TE prior to DAA treatment was 12.65 kPa (IQR 9.45-19.2 kPa) and decreased to 8.55 kPa (IQR 5.93-15.25) post-treatment. This finding is statistically significant (P<.001) and equals a TE regression of 32.4% after DAA treatment. Median FIB-4 and APRI values significantly decreased from 2.54 (IQR 1.65-4.43) and 1.10 (IQR 0.65-2.43) to 1.80 (IQR 1.23-2.84, P<.001) and 0.43 (IQR 0.3-0.79, P<.001) respectively.



Patients with SVR after DAA therapy showed significant regression of TE values. Rapid decrease in TE was in concordance with regression of validated fibrosis scores FIB-4 and APRI. It remains to be examined whether this indicates a true regression of fibrosis or merely resolution of chronic liver inflammation with subsequent improvement of TE values and laboratory parameters.
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Jacqueline A
JA
Bachofner
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Piero V
PV
Valli
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Arne
A
Kröger
Division of Gastroenterology and Hepatology, Hospital St. Gallen, St. Gallen, Switzerland.
Irina
I
Bergamin
Division of Gastroenterology and Hepatology, Hospital St. Gallen, St. Gallen, Switzerland.
Patrizia
P
Künzler
Epatocentro Ticino, Lugano, Switzerland.
Adriana
A
Baserga
Division of Infectious Diseases, University Hospital Zürich, Zürich, Switzerland.|Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
Dominique
D
Braun
Division of Biostatistics, Institute of Social and Preventive Medicine Zürich, University of Zürich, Zürich, Switzerland.
Burkhardt
B
Seifert
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Anja
A
Moncsek
Division of Infectious Diseases, University Hospital Zürich, Zürich, Switzerland.
Jan
J
Fehr
Division of Gastroenterology and Hepatology, Hospital St. Gallen, St. Gallen, Switzerland.
David
D
Semela
Epatocentro Ticino, Lugano, Switzerland.
Lorenzo
L
Magenta
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Beat
B
Müllhaupt
Epatocentro Ticino, Lugano, Switzerland.
Benedetta
B
Terziroli Beretta-Piccoli
Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Swiss HPB Center, University Hospital Zürich, Zürich, Switzerland.
Joachim C
JC
Mertens
D000998:Antiviral Agents / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000166:cytology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D054459:Elasticity Imaging Techniques; D005260:Female; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000072230:Sustained Virologic Response; D013557:Switzerland
D000998:Antiviral Agents; D015415:Biomarkers; D001219:Aspartate Aminotransferases

APRI
; 
DAA
; 
SVR
; FIB-4; chronic hepatitis C; liver fibrosis; transient elastography