DAA Treatment and Hepatic Fibrosis Improvement in HCV: What's the Link?

A significant decrease in the mean fibrosis score was observed in patients with SVR following treatment
A significant decrease in the mean fibrosis score was observed in patients with SVR following treatment

According to the results of a prospective cohort study, 57% of patients with hepatitis C virus (HCV) infection who achieved sustained virologic response (SVR) showed no improvement in hepatic fibrosis.

The study, which took place at a tertiary liver center, aimed to determine whether direct-acting antiviral (DAA) therapy reduced fibrosis and assessed whether any predictors of treatment failure existed at 1-year follow-up. A total of 193 patients were divided into 2 groups: those who achieved SVR (N=143) and those who failed treatment or did not receive it (N=50).

Ultrasound elastography (UE) was used to assess fibrosis stage at baseline and at follow-up at 1 year. “Non-improvement in fibrosis staging was defined as remaining in the same fibrosis stage or descending to a higher fibrosis stage at follow-up,” the study authors explained. They added, “Improvement in fibrosis staging was defined as ascending to a lower fibrosis stage at follow-up.” 

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Baseline demographics of the patients showed that 58% of the patients were male, 62% were non-African American, and 87% of patients had genotype 1 infection. The average age of the patients included in the study was 58 years.

The study authors reported that a significant decrease in the mean fibrosis score was observed in patients with SVR following treatment (7.66 before treatment to 6.23 after treatment; 1.43 reduction; =.00). Additionally, an increase in the mean fibrosis score was observed in patients who did not receive treatment or failed treatment (5.81 to 6.21; 0.40 increase; =.274).

Results of the study also showed that in patients who achieved SVR, only 43% showed improvements in fibrosis staging at follow-up after 1 year, while 57% stayed in the same stage or worsened.

“In multivariate analysis, patients with pre-treatment severe fibrosis or cirrhosis (F3/F4) (OR 11.20, P=.000) were more likely to have no improvement in fibrosis staging at 1-year follow-up,” the study authors reported. They added, “Age, race, BMI, genotype, current alcohol use, or gender did not independently predict non-improvement in fibrosis staging.”

According to the results of this study, hepatic fibrosis did not improve in more than half of HCV patients who achieved SVR. The study authors concluded that “More studies with longer follow-up data are needed to identify other factors that impact fibrosis resolution.”

Reference

Kommineni VT et al. Factors Associated with Lack of Improvement in Fibrosis Following HCV Treatment. Presented at AASLD The Liver Meeting 2018. Study number 0603.