Hepatic fibrosis in patients with chronic hepatitis C assessed by transient elastography: implications for determining the efficacy of antiviral therapy

ABSTRACT

Background: the efficacy of combination therapy with peginterferonplus ribavirin to eradicate viral infection in patients withchronic hepatitis C (CHC) is well established; moreover, it is ableto arrest or even reverse liver fibrosis.Aims: to analyze the measurements of hepatic stiffness as anindex of liver fibrosis using transient elastography (TE) in patients who underwent a sustained virological response (SVR) duringlong-term follow-up; comparing the changes in the severity of fibrosis with non-responders patients. Material and methods: after hepatic fibrosis was studied in three patients with CHC who underwent a SVR during long-term follow up, a prospective study was initiated in 24 patients withCHC who received combination therapy to compare the evolution of fibrosis in those with SVR and those who were non-responders.The genotype of hepatitis C virus (HCV) and the degree of viremia were determined. METAVIR scoring system was used for liver fibrosis. Hepatic stiffness was measured by TE. Results: of the initial three patients pre-treatment liver biopsiesrevealed active disease and fibrosis (stage 3) in two and mildfibrosis (stage 1) in one. After several years of follow up serum AST/ALT levels were normal and HCV RNA was undetectable ineach case; in contrast to the baseline histological assessments of fibrosis, values for hepatic stiffness (3.4-6.9 KPa) were compatible with an absence of any appreciable hepatic fibrosis. In the prospective study, 8 patients underwent a SVR and 16 were nonresponders.TE indicated that the severity of hepatic fibrosis in theSVR group improved in 7 (88%) patients, whereas in the non-responderit improved in only 4 (25%) (p < 0.05). The difference between development of severe fibrosis (F>=3) in responders andnon-responders was not significant (p = 0.23), possibly due to the small sample size...(AU)