Assessment of Liver Fibrosis after Direct-Acting Antiviral Therapy in Compensated and Decompensated HCV-related Liver Disease

2019 ◽  
Vol 4 (04) ◽  
Author(s):  
Mohammed Amin Mohammed ◽  
Nesreen Moustafa Omar
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Virologic Response ◽  
Post Treatment ◽  
Direct Acting Antiviral ◽  
Non Invasive ◽  
Apri Score ◽  
Fibrosis Regression ◽  
Chronic Hcv ◽  
Direct Acting

Background and Aim: Successful HCV eradication was associated with significant improvement in liver histology. Direct-acting antiviral (DAAs) therapy is associated with a significantly higher rate of sustained virologic response (SVR) compared to interferon-based therapies. Several non-invasive methods have been developed and validated with robust reliability and clinical applicability. Although these non-invasive tests are valuable in evaluating hepatic fibrosis prior to HCV therapy, use of these measures in monitoring fibrosis regression after HCV eradication with DAAs is currently limited. So, the aim was to assess the impact of DAAs on fibrosis regression in chronic HCV Egyptian patients with either compensated or decompensated liver disease. Patients and Methods: A total of 228 Egyptian chronic HCV patients eligible for treatment with DAAs were enrolled in this prospective study. All subjects selected from outpatient's Hepatology clinic of Mansoura university hospital received DAAs with different regimens after consent. The endpoint was a sustained virologic response at 12 (SVR12) weeks post-treatment. All participants were evaluated non-invasively by fibrosis-4 index (FIB-4), Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) score, and liver stiffness measurement (LSM) by fibroscan before DAAs treatment, at end of treatment (EOT), 6- and 12-months post-treatment. Results: SVR achieved by DAAs therapy was associated with significant improvement (p ˂0.05) of non-invasive fibrosis markers (FIB-4, APRI score, and LSM by fibroscan) from baseline compared to EOT, 6-and 12-months post-treatment among HCV patients with significant and advanced liver fibrosis. Conclusions: fibrosis regression after DAAs therapy regardless of fibrosis grade. Baseline LSM by fibroscan predicted fibrosis regression.

scholarly journals NS34A resistance-associated substitutions in chronic hepatitis C in Upper Egypt and regression of liver fibrosis after direct-acting antiviral therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nahed A. Makhlouf ◽  
Mohamed Farouk ◽  
Hanan Mohamed Nafeh ◽  
Ahmad Farooq Alsayed Hasanain ◽  
Mohamed Ahmed El-Mokhtar ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Liver Stiffness ◽  
Upper Egypt ◽  
Hcv Genotype ◽  
Direct Acting Antiviral ◽  
Non Invasive ◽  
Fibrosis Regression ◽  
Chronic Hcv ◽  
Direct Acting ◽  
The Impact

Abstract Background Viral resistance-associated substitutions (RASs) can develop in the setting of DAAs therapy (i.e., emerging RASs). Long-term monitoring of fibrosis regression after achieving SVR to simiprevir (SMV)/sofosbuvir (SOF) is essential. The aim of this study was to determine the prevalence of baseline and emerging NS34A RASs in chronic HCV patients in Upper Egypt and to assess the impact of SMV/SOF therapy on liver stiffness. Results The enrolled 59 patients had HCV genotype 4a without any baseline RASs in the NS34A region. 96.6% (57/59) of patients achieved sustained virological response (SVR12). Of the two patients who failed to achieve SVR12, one of them developed emerging RASs Q80K in the NS34A region. Seventy-two weeks after SMV/SOF therapy, the percentage of patients with liver fibrosis stage (F2, F3, and F4) decreased from 75.4% before treatment to 42.1% after treatment. The combination of SOF and SMV appeared to be well tolerated. Conclusions All patients had HCV genotype 4a without any baseline RASs in the NS34A region. In addition, there was improvement of non-invasive measures of liver fibrosis in patients who achieved SVR, 72 weeks after SMV/SOF therapy.

scholarly journals Evaluation of HCV-related liver fibrosis post-successful DAA therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nermine Ehsan ◽  
Dina Sweed ◽  
Maha Elsabaawy
Keyword(s):  
Liver Fibrosis ◽  
Main Body ◽  
Dynamic Nature ◽  
Direct Acting Antiviral ◽  
Non Invasive ◽  
Fibrosis Regression ◽  
Direct Acting ◽  
The Impact ◽  
Post Therapy ◽  
The Ideal

Abstract Background The rapidly developing era of direct-acting antiviral regimens (DAAs) for more than one hepatitis C virus (HCV) genotype had certainly alleviated HCV burden all over the world. Liver fibrosis is the major dramatic complication of HCV infection, and its progression leads to cirrhosis, liver failure, and hepatocellular carcinoma. The impact of DAAs on liver fibrosis had been debatably evaluated with undetermined resolution. Main body The aim of this review is to accurately revise the effects of DAA regimens on liver fibrosis which can either be regression, progression, or non-significant association. Liver fibrosis regression is a genuine fact assured by many retrospective and prospective clinical studies. Evaluation could be concluded early post-therapy reflecting the dynamic nature of the process. Conclusions The ideal application of DAA regimens in treating HCV has to be accomplished with efficient non-invasive markers in differentiating proper fibrosis evaluation from necroinflammation consequences. Liver biopsy is the gold standard that visualizes the dynamic of fibrosis regression.

scholarly journals Angiopoietin-2 as a predictor of fibrosis regression in chronic hepatitis C virus patients after direct-acting antiviral drugs

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Amira Isaac ◽  
Tarek Maged El Sakaty ◽  
Sarah Hamdan Hussein ◽  
Hany Samir Rasmy
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Disease Progression ◽  
Antiviral Agents ◽  
Direct Acting Antiviral ◽  
Fibrosis Regression ◽  
Chronic Hcv ◽  
Direct Acting ◽  
Angiopoietin 2 ◽  
Direct Acting Antiviral Agents

Abstract Background HCV infection is a major health concern. Disease progression to fibrosis, cirrhosis, and HCC is aided by the persistence of inflammatory reactions and cellular damage. Moreover, angiogenesis was found to have a substantial pathogenic role in disease progression. Serum Angiopoietin-2 appears to be correlated with liver stiffness in chronic HCV and its elevation is linked to disease progression from chronic hepatitis to cirrhosis. The aim of this study was to evaluate the role of serum Angiopoietin-2 in the prediction of regression of fibrosis in chronic HCV patients receiving direct-acting antiviral agents. Forty Egyptian chronic HCV patients for whom direct-acting antiviral agent (DAA) therapy was planned were included. All patients underwent assessment twice, at baseline and at SVR12, for standard laboratory tests, measurement of fibrosis using FibroScan, FIB-4 and APRI scores, and Angiopoietin-2 level. Results Statistically significantly higher levels of baseline Ang-2 were detected with the progression of fibrosis stages with a p-value of <0.001. The best cutoff value of baseline Ang-2 in discrimination of liver cirrhosis (F4) from F0-F3 was > 630 pg/ml with 85.71% sensitivity and 84.85% specificity. A statistically significant decline of Ang-2 (from 464.3±237.2 pg/ml to 401.3±277.1 pg/ml) was noted after the achievement of SVR12 with a p-value < 0.001. Regression of liver fibrosis in this study is defined as a decrease of more than or equal to one stage in liver fibrosis. Lower baseline fibrosis stages and other non-invasive scoring systems (FIB-4 and APRI scores) were associated with regression of fibrosis following successful DAAs treatment. However, higher baseline Ang-2 levels were significantly associated with non-regression of fibrosis, and at a cutoff of >680 pg/ml, it might predict non-regression of fibrosis after successful eradication of HCV with DAAs with 93.33% sensitivity and 70% specificity. Conclusions Angiopoietin-2 can be a useful predictor of fibrosis regression in chronic HCV patients receiving direct-acting antiviral agents. Elevated baseline Angiopoietin-2 and advanced fibrosis stages may predict non-regression of liver fibrosis.

Direct-acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease

Hepatology ◽  
2018 ◽  
Vol 68 (3) ◽  
pp. 827-838 ◽  
Author(s):  
Lisa I. Backus ◽  
Pamela S. Belperio ◽  
Troy A. Shahoumian ◽  
Larry A. Mole
Keyword(s):  
Liver Disease ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Advanced Liver Disease ◽  
Direct Acting Antiviral ◽  
Direct Acting

scholarly journals Lymphocyte Landscape after Chronic Hepatitis C Virus (HCV) Cure: The New Normal

2020 ◽  
Vol 21 (20) ◽  
pp. 7473
Author(s):  
Alip Ghosh ◽  
Sara Romani ◽  
Shyam Kottilil ◽  
Bhawna Poonia
Keyword(s):  
Hepatocellular Carcinoma ◽  
Immune System ◽  
Virologic Response ◽  
Viral Clearance ◽  
Liver Pathology ◽  
Direct Acting Antiviral ◽  
Chronic Hcv ◽  
Direct Acting ◽  
Immune Defects ◽  
The Impact

Chronic HCV (CHC) infection is the only chronic viral infection for which curative treatments have been discovered. These direct acting antiviral (DAA) agents target specific steps in the viral replication cycle with remarkable efficacy and result in sustained virologic response (SVR) or cure in high (>95%) proportions of patients. These treatments became available 6–7 years ago and it is estimated that their real impact on HCV related morbidity, including outcomes such as cirrhosis and hepatocellular carcinoma (HCC), will not be known for the next decade or so. The immune system of a chronically infected patient is severely dysregulated and questions remain regarding the immune system’s capacity in limiting liver pathology in a cured individual. Another important consequence of impaired immunity in patients cleared of HCV with DAA will be the inability to generate protective immunity against possible re-infection, necessitating retreatments or developing a prophylactic vaccine. Thus, the impact of viral clearance on restoring immune homeostasis is being investigated by many groups. Among the important questions that need to be answered are how much the immune system normalizes with cure, how long after viral clearance this recalibration occurs, what are the consequences of persisting immune defects for protection from re-infection in vulnerable populations, and does viral clearance reduce liver pathology and the risk of developing hepatocellular carcinoma in individuals cured with these agents. Here, we review the recent literature that describes the defects present in various lymphocyte populations in a CHC patient and their status after viral clearance using DAA treatments.

Predictors for Fibrosis Regression in Chronic HCV Patients after the Treatment with DAAS: Results of a Real-world Cohort Study

2020 ◽  
Vol 20 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Hanan Soliman ◽  
Dina Ziada ◽  
Marwa Salama ◽  
Manal Hamisa ◽  
Rehab Badawi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Virologic Response ◽  
Factors Affecting ◽  
Observational Cohort ◽  
Fibrosis Regression ◽  
One Year ◽  
Chronic Hcv ◽  
Direct Acting

Introduction: The goal of treatment of chronic hepatitis C (HCV) is viral eradication. However, obtaining histological regression is even more important, because it will reduce the overall morbidity and mortality related to cirrhosis. Introduction of direct-acting antivirals (DAAs) in HCV improves rates of sustained virologic response (SVR). However, fibrosis regression has not been extensively assessed. The aim of this study was to detect the factors affecting fibrosis regression in chronic HCV patients treated with interferon containing regimens versus interferon-free DAA regimens. Methods: This prospective observational cohort study was conducted at the Tropical Medicine and Infectious Diseases Department, Tanta University, Egypt, between October 2015 and December 2017. Transient elastography (FibroScan®) examination was performed before therapy, at SVR12, 6 months and 1 year after completing therapy for cured patients. Results: Reduction in fibrosis was reported in; 46.7% and 49.3% of patients with moderate fibrosis, and 89% and 78.7% of patients with advanced fibrosis after one year of interferon containing and interferon free DAAs regimens respectively. Using multiple regression analysis; it was found that BMI, degrees of hepatic stiffness and steatosis were related to regression of hepatic fibrosis after therapy. Conclusion: DAAs with or without interferon resulted in a significant reduction of liver fibrosis. BMI, steatosis and liver stiffness were independent factors for fibrosis regression in chronic HCV patients treated with DAAs. Further studies are needed to explore the mechanism by which steatosis affects HCV related fibrosis regression after treatment with DAAs.

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