Role of Liver Stiffness Measurement in Predicting HCC Occurrence in Direct-Acting Antivirals Setting: A Real-Life Experience

Direct-acting antivirals (DAAs) induce a rapid virologic response (SVR) in up to 99% of chronic hepatitis C patients. The role of SVR by DAAs on the incidence or recurrence of hepatocellular carcinoma (HCC) is still a matter of debate, although it is known that SVR does not eliminate the risk of HCC. In this review, we made an updated analysis of the literature data on the impact of SVR by DAAs on the risk of HCC as well as an assessment of risk factors and the role of epigenetics. Data showed that SVR has no impact on the occurrence of HCC in the short–medium term but reduces the risk of HCC in the medium–long term. A direct role of DAAs in the development of HCC has not been demonstrated, while the hypothesis of a reduction in immune surveillance in response to the rapid clearance of HCV and changes in the cytokine pattern influencing early carcinogenesis remains to be further elucidated. HCV induces epigenetic alterations such as modifications of the histone tail and DNA methylation, which are risk factors for HCC, and such changes are maintained after HCV clearance. Future epigenetic studies could lead to identify useful biomarkers and therapeutic targets. Cirrhosis has been identified as a risk factor for HCC, particularly if associated with high liver stiffness and α-fetoprotein values, diabetes and the male sex. Currently, considering the high number and health cost to follow subjects’ post-HCV clearance by DAAs, it is mandatory to identify those at high risk of HCC to optimize management.

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Are direct-acting antivirals safe and effective in hepatitis C virus-cryoglobulinemia? virological, immunological, and clinical data from a real-life experience

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001239 ◽

2018 ◽

Vol 30 (10) ◽

pp. 1208-1215 ◽

Cited By ~ 5

Author(s):

Matteo Passerini ◽

Monica Schiavini ◽

Carlo F. Magni ◽

Simona Landonio ◽

Fosca Niero ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Clinical Data ◽

Life Experience ◽

Real Life ◽

Direct Acting Antivirals ◽

Direct Acting

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IDDF2019-ABS-0108 Hepatic decompensation risk is reduced, but not eliminated after direct-acting antivirals: the role of spleen stiffness measurement

10.1136/gutjnl-2019-iddfabstracts.13 ◽

2019 ◽

Author(s):

Giovanni Marasco ◽

Elton Dajti ◽

Federico Ravaioli ◽

Antonio Colecchia ◽

Maria Letizia Bacchi Reggiani ◽

...

Keyword(s):

Direct Acting Antivirals ◽

Hepatic Decompensation ◽

Stiffness Measurement ◽

Spleen Stiffness ◽

Direct Acting

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Real-Life Use of 3 Direct-Acting Antiviral Regimen in a Large Cohort of Patients with Genotype-1b HCV Compensated Cirrhosis

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.263.iac ◽

2017 ◽

Vol 26 (3) ◽

pp. 275-281 ◽

Cited By ~ 6

Author(s):

Liana Gheorghe ◽

Speranta Iacob ◽

Manuela Curescu ◽

Ciprian Brisc ◽

Cristina Cijevschi ◽

...

Keyword(s):

Transient Elastography ◽

Sustained Viral Response ◽

Liver Stiffness ◽

Real Life ◽

Liver Stiffness Measurement ◽

Direct Acting Antiviral ◽

Genotype 1B ◽

End Of Treatment ◽

Clinically Significant ◽

Direct Acting

Background & Aims: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir (OBV/PTV/r+DSV) is one of the elective direct-acting antivirals (DAAs) recommended by international guidelines and the only one covered by the National Insurance System in Romania until November 2016. Our aim was to present the first prospective Romanian cohort evaluating the effectiveness and safety in clinical practice of this 3DAA combination in patients with HCV genotype-1b Child A liver cirrhosis.Methods: 681 patients received OBV/PTV/r+DSV+RBV for 12 weeks and were assessed clinically and biologically at baseline, week 4, 8, 12 (end of treatment, EOT), and 12 weeks after therapy (sustained viral response, SVR).Results: Per protocol, EOT virological response was 99.8% and SVR12 rate was 99.4%. Adverse events were present in 36.4% of patients. Permanent discontinuation of 3DAA regimen due to side effects was reported in 11 patients (1.6%). In 47.6% (185/389) of patients, Transient Elastography values were >20kPa (defined as clinically significant portal hypertension, CSPH) at baseline. Independent variables associated with CSPH were: baseline cholesterol level (p=0.003), platelet count <120,000/mm³ (p=0.02), MELD score (p=0.01).Liver stiffness measurement has significantly improved between baseline (26.6±12.7kPa) and SVR12 (21.6±11.8kPa) (p<0.0001). The same was true for APRI score (2.66±0.15 at baseline vs 0.85±0.02 at SVR12, p<0.0001) and FIB4 score (5.53±0.28 vs 3.24±0.08, p<0.0001), but not for Lok score (0.57±0.01 vs 0.63±0.01, p<0.0001).Conclusions: We report a high efficacy of the 3DAA regimen in a homogeneous compensated HCV genotype-1b liver cirrhosis population, in a real-life setting. Noninvasive fibrosis scores significantly improved at SVR12.Abbreviations: AE: adverse effect; AFP: alpha feto-protein; CSPH: clinically significant portal hypertension; DAA: direct-acting antiviral; EOT: end of treatment; GT: genotype; HCV: hepatitis C virus; HCC: hepatocellular carcinoma; LSM: liver stiffness measurement; MELD: Model of end stage liver disease; NHIA: National Health Insurance Agency; OBV/PTV/r+DSV: Ombitasvir/Paritaprevir/ritonavir/Dasabuvir; RBV: ribavirin; SAE: serious adverse effect; SVR: sustained viral response; TE: transient elastography.

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