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Regression of liver fibrosis over a 24-week period after completing direct-acting antiviral therapy in patients with chronic hepatitis C receiving care within the national hepatitis C elimination program in Georgia: results of hepatology clinic HEPA experience

Dolmazashvili, Ekaterinea,b,c; Abutidze, Akakia,b; Chkhartishvili, Nikolozb; Karchava, Marinea,b; Sharvadze, Lalia,b,c; Tsertsvadze, Tengiza,b,c

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1223–1230
doi: 10.1097/MEG.0000000000000964
Original Articles: Hepatitis

Objective We assessed the impact of direct-acting antiviral (DAA) therapy on liver fibrosis regression measured by transient elastography (TE) in patients with chronic hepatitis C virus (HCV) infection.

Patients and methods A prospective cohort study was carried out in HCV monoinfected patients with advanced liver fibrosis or cirrhosis receiving interferon (IFN)-containing or IFN-free DAA therapy. Liver stiffness (LS) score more than 14.5 kPa indicated LS-defined cirrhosis. The primary outcome was improvement in liver stiffness measurement (LSM) at week 24 after treatment measured as (a) decrease in the median LS compared with baseline and (b) at least a 20% decrease in LSM compared with baseline. A multivariate logistic regression model was utilized to identify the factors associated with at least a 20% improvement in LSM.

Results Of a total of 304 patients, 172 (56.6%) had LS-defined cirrhosis before treatment. LSM decreased from the baseline median value of 16.9 (interquartile range: 11.8–27.7) kPa to a post-treatment week 24 score of 11.9 (interquartile range: 8.2–20.9) kPa (P<0.0001). Of a total of 304 patients, 198 (65.1%) achieved at least a 20% reduction in LS. In multivariate logistic regression analysis, sustained virological response (SVR) was associated significantly with this reduction (P<0.0001). The addition of IFN to the treatment regimen had no impact on the decrease in LSM. Despite decreasing baseline LSM, more than half of the LS-defined cirrhotic patients remained cirrhotic at week 24 after treatment.

Conclusion In patients with advanced fibrosis, pretreatment LS significantly reduced during DAA therapy. SVR was the only independent factor associated with the regression in LSM. However, irrespective of achieving SVR, liver damage still persisted in a substantial proportion of patients. Thus, early treatment of HCV-infected patients can significantly prevent residual liver damage.

aHepatology Clinic ‘HEPA’

bInfectious Diseases, AIDS and Clinical Immunology Research Center

cIvane Javakhishvili Tbilisi State University, Tbilisi, Georgia

Correspondence to Ekaterine Dolmazashvili, MD, MPH, Hepatology Clinic, Tbilisi 0160, Georgia Tel: +995 32 243 1111/+995 59 232 3200; fax: +995 32 239 9144; email: ekaterined@yahoo.com

Received April 9, 2017

Accepted June 27, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.