The evolution of liver fibrosis in patients with chronic hepatitis C virus (HCV) infection after interferon-free therapy

Abstract

Introduction. In patients with chronic hepatitis C, the viral infection is a constant trigger of inflammation, which subsequently induces formation of fibrosis (Sangiovanni A, 2006), which lead to portal hypertension and hepatocarcinogenesis (Pungpapong S, 2007). Until recently, liver fibrosis and cirrhosis were regarded as irreversible processes (Bonis PA, 2001), however, several studies have reported that regression of liver fibrosis can be achieved using potent antiviral agents (DAA) in patients with chronic hepatitis C by improving hepatic necroinflammation and alleviating damage. Aim of the study. This review aims to summarize current researches that assessed the impact of HCV direct-acting antiviral (DAA) therapy on changes in liver fibrosis (stiffness – LS) measured by transient electrography. Materials and methods. A literature review of the articles published on HINARI and Pubmed databases between 2014 and 2020 years was done. To identify relevant studies on this topic we used the key words: „hepatitis C”, „ direct-acting antiviral”, sustained virological response”, „hepatic fibrosis”, “and liver stiffness”. We analyzed about 40 different researches and compared the results that they provide. Results. We compared fibroscan data of different studies that were collected at the baseline (T0) and at the end of interferon-free treatment (EoT) in patients with HCV infection. SVR was reached in about 97.5% cases. On the whole, LS decreases by 15-35% at the EoT (Bachofner JA, 2017, V. Knop, 2016). One year after treatment, LS decreases by an additional 15%, suggestive of fibrosis regression (Laursen, et al., 2019). Factors associated with a reduction in fibrosis as measured were lower BMI, bilirubin, FIB-4, and LS by transient elastography, as well as higher liver fibrosis value at registry enrollment (Ira Jacobson, 2019), SVR was associated significantly with this reduction (Dolmazashvili E, 2017). Failure to achieve improvement in liver stiffness were associated with relapses, low baseline liver stiffness measurement (A. Elsharkawy, 2017), baseline high glucose, low ALT, low platelets, presence of esophageal varices (Persico M, 2018). Conclusions. In HCV patients with advanced fibrosis, pretreatment LS significantly reduced during DAA therapy, SVR was the only independent factor associated with this regression.