Background: Liver stiffness is now widely employed as a surrogate measure for liver fibrosis and staging of liver disease. Subsequently, vibration controlled transient elastography (VCTE) is becoming more commonly accepted and utilized to evaluate liver stiffness, likely driven by its dependable diagnostic accuracy and ease of use. This non-invasive technique allows for safer data collection as compared to traditional methods of liver staging such as liver biopsy, and more accurate interpretation compared to biochemical staging allowing for effective trending of liver staging over time. The advent of direct acting antiviral (DAA) based therapy has revolutionized the management of Hepatitis C virus (HCV) infection with high cure rates for all genotypes. Longitudinal studies have demonstrated reduction in hepatic decompensation, hepatocellular carcinoma, and survival benefits after sustained virologic response (SVR); however, there is little data to assess the immediate effects on liver stiffness/staging after achieving SVR. The objective of this study is to evaluate the effect of SVR after DAA based therapy for HCV on liver stiffness as measured by VCTE.
Methods: This is a retrospective chart review study conducted at the W. G. Hefner VA Medical Center, Salisbury, NC from December 2013 to March 2016. All HCV patients who had undergone VCTE at least 6 months apart were reviewed. The Treatment Group (n=25) consisted of HCV infected patients who were treated with a DAA based regimen, achieved SVR, and had VCTE evaluation before treatment and after SVR. The Control Group (n=64) consisted of HCV infected patients who were not being treated for HCV and had two VCTE data points over time. VCTE data (reported as kPa) were compared to assess trend.
Results: Liver stiffness improved in 92% (23/25) of the Treatment Group (T) and only 39% (25/64) of the Control Group (C). When accounting for differences in baseline kPa (using the least squares mean method), our model estimates an absolute difference of 5.1 kPa between C (10.2 kPa) and T (5.2 kPa) at time of follow up (p=0.0004, 95% confidence interval 2.3, 7.8). Review Panel A for further details.
Conclusion: Successful treatment of HCV with SVR after DAA therapy results in a significant improvement in liver stiffness.
C. De Comarmond, None