446. Direct Acting Anti-Viral (DAA) Therapy for Chronic Hepatitis C Virus (HCV) Infection Leads to Regression of Liver Fibrosis, Assessed by Serial Transient Elastography (Fibroscan)
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Chan IDSA poster 10-21-2016 FINAL.pdf (287.1 kB)
  • Background: Liver fibrosis stage determines clinical outcomes from chronic HCV infection. Those who achieved sustained virologic response (SVR) with interferon-based therapies had regression of fibrosis over time. We aimed to assess the effect of HCV DAA therapy on changes in liver fibrosis, using Fibroscan.

     

    Methods: Patients being treated with DAA therapy for chronic HCV were enrolled in this observational cohort study. We performed pre-treatment Fibroscans, then repeat scans at end of treatment (EOT) and 12 months post-treatment. The primary outcome was significant improvement in liver fibrosis (>30% decrease in Fibroscan score 12 months after treatment), relative to baseline. Multivariable logistic regression analysis was used to control for confounding. Signed rank test was used to assess change in liver stiffness measurement (LSM) between time points.

     

    Results: Of the 47 patients who have completed the protocol, 27 (57.4%) had significant liver fibrosis (>7.3 kPa or ≥F2) at baseline, and 27 (57.4%) were treatment-experienced. SVR rate was 95.7%, with 2 relapsers. The primary outcome of >30% improvement in LSM was met in 24 (51.1%) patients. The 2 relapsers did not reach this outcome. Of those with baseline significant fibrosis (≥F2), 13 (48.2%) improved from Metavir ≥F2 to <F2. Baseline LSM >7.3 kPa was associated with reaching the primary outcome, and remained significant after controlling for BMI and elevated ALT (OR=8.8; 95% CI 1.9-37.2).

     

    Conclusion: Treatment of chronic HCV with DAAs leads to clinically relevant reduction in liver fibrosis over the first year post-treatment, measured by Fibroscan, even after controlling for elevated ALT. This outcome was more likely in those with baseline significant liver fibrosis, with some experiencing improved Metavir fibrosis stage.

     

    1. Intra-patient Fibroscan score changes

    Baseline Fibroscan >7.3 kPa (N=27)

    Median LSM change in kPa (IQR)

    P*

    12 months post-treatment vs. baseline

    -4.5 (-7.1, -2.0)

    <0.0001

    12 months post-treatment vs. EOT

    -1.4 (-4.0, -0.3)

    0.0002

    EOT vs. baseline

    -2.7 (-7.6, -0.5)

    0.0013

    *Signed rank test

     

     

    2. Fibrosis regression by Metavir stage

     

    Baseline ≥F2 (LSM >7.3 kPa) (N=27)

    Baseline ≥F3 (LSM >8.5 kPa) (N=23)

    Regressed to <F2 (LSM ≤7.3 kPa) at 12 months post-treatment (%)

    13 (48.2)

    9 (39.1)

     

     

     
                       

     

         

    Justin Chan, MD1, Neliswa Gogela, MD2, Hui Zheng, PhD3, Sara Lammert, MPH4, Tokunbo Ajayi, MD5, Zachary Fricker, MD5, Arthur Kim, MD, FIDSA4,6, Gregory Robbins, MD, MPH, FIDSA7 and Raymond T. Chung, MD8, (1)Infectious Disease, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (2)Hepatology, University of Cape Town, Cape Town, South Africa, (3)Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (4)Infectious Diseases, Massachusetts General Hospital, Boston, MA, (5)Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (6)Medicine, Harvard Medical School, Boston, MA, (7)Infectious Disease, Massachusetts General Hospital, Boston, MA, (8)Gastrointestinal Division, Massachusetts General Hospital, Boston, MA

    Disclosures:

    J. Chan, None

    N. Gogela, None

    H. Zheng, None

    S. Lammert, None

    T. Ajayi, None

    Z. Fricker, None

    A. Kim, None

    G. Robbins, None

    R. T. Chung, None

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