Introduction: Direct-acting antivirals (DAAs) have resulted in improvement in the virologic cure rate of HCV infection. However, tools to measure regression of hepatic fibrosis after HCV eradication are not perfect. Liver biopsy is not always appropriate and transient elastography has limited availability. Alternative ways to monitor for regression of fibrosis are required in clinical practice. The AST-to-Platelet-Ratio-Index (APRI) and Fibrosis-4 (Fib-4) are validated tools that predict presence of hepatic fibrosis. We examined if treatment of HCV infection resulted in sustained improvement in the APRI and Fib-4 scores.
Clinic records of adult patients with chronic HCV infection who received treatment in a single center were reviewed over a 5-year period. Sustained virologic response (SVR) was achieved if the HCV RNA titer was undetected 12 weeks or more after treatment completion. APRI and Fib-4 scores were calculated before and 12-24 weeks after treatment completion. Cirrhosis was ascertained based on laboratory and imaging data or biopsy.
Continuous variables are reported as mean (± SD). Multivariable linear and stepwise linear regression analyses were performed to examine the association between SVR12 and the APRI/FIB-4 scores 12-24 weeks after treatment completion. The analyses were adjusted for baseline APRI/FIB-4 scores, BMI, cirrhosis, use of peg-interferon, and genotype 3.
153 patients were identified. Mean age was 51.2 ± 14.0 years. Mean treatment duration was 14.7 ± 8.2 weeks. 68% were men, 3.3% were HIV co-infected. Genotype 1 was predominant (1a 46%, 1b 17%), followed by genotype 2 (18%), genotype 3 (16%), and genotypes 4-6 (3%). 22% of patients had cirrhosis, 14% received an interferon containing regimen.
In the unadjusted analysis, patients who achieved SVR12 had a significant decline in the mean APRI and Fib-4 scores compared to those who did not achieve SVR12. These results remained robust in the multivariable linear regression analyses where all the covariates of interest were forced into the models, as well as in the stepwise analyses where non-significant covariates were eliminated from the models.
Conclusion: We herein demonstrate that treatment of chronic HCV infection results in improvement in the APRI and Fib-4 scores among patients who achieved SVR12 suggesting regression of hepatic fibrosis. In the absence of transient elastography, physicians should consider relying on these surrogate markers for risk stratification.