Changes in Liver Steatosis as Well as Liver Fibrosis in Patients with Chronic Hepatitis C After Successful Direct-Acting Antiviral Therapy

Introduction and Objectives: After successful treatment of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs), the stage of liver fibrosis decreases by time. Here, we aimed to assess the changes in liver fibrosis stage using transient elastography (TE) after successful DAA therapy in HCV-infected cirrhotic patients who referred to Shariati hospital from 2016 to 2017. Material and Methods: In this observational cohort, all HCV-infected cirrhotic patients who were treated with a combination of sofosbuvir/daclatasvir and had achieved sustained virologic response (SVR) and also had undergone pre- and post-treatment TE, were enrolled. The primary outcome was the changes in TE parameters six months after the end of treatment compared to baseline. Results: A total of 442 eligible subjects received DAA therapy. Overall, the SVR rate was 96.6%. Of these, 149 patients had completed the protocol and were enrolled. The mean age of patients was 56.1±10.3 years and the predominant sex was male (77.9%). The median (Q1-Q3) liver stiffness (LS) value at baseline was 26.3 kPa (18.1-38 kPa), which significantly decreased to 20.9 kPa (12-29.7 kPa) [z = -8.45, p-value < 0.001]. Also, the liver steatosis of patients with baseline CAP ≥ 220 dB/m had a significant response to treatment [z = -2.3, p-value = 0.023]. Based on multivariate analysis, a higher baseline liver fibrosis stage was the only determinant of LS values improvement in our study. Conclusion: Successful HCV eradication in patients with liver fibrosis results in significant improvement in LS, even in cirrhotic patients.