Evaluating the effect of direct-acting agents on liver fibrosis, by real-time elastography, Fibroscan and FIB4 score in chronic HCV patients

Background One of the most important questions is what happens with liver fibrosis following a sustained virological response (SVR), although the current anti-HCV therapies were not designed to be antifibrotic. Liver biopsy was replaced by multiple noninvasive means, which were validated in chronic HCV patients, such as Fibroscan, seromarkers such as aminotransferase-to-platelet ratio index (APRI) and FIB4 scores, and new nonvalidated means such as real-time elastography (RTE). The aim of the study was to evaluate the early changes of liver fibrosis after direct-acting agents (DAAs) using these noninvasive means. Materials and methods This was a prospective study that included 200 chronic HCV-naive patients during the period spanning from December 2014 to January 2016. All patients received sofosbuvir − based treatment regimen (with or without pegylated interferon). They were evaluated using Fibroscan, RTE, APRI and FIB4 scores at the baseline and SVR24. Results All the studied patients showed a statistically significant decline in ALT, AST, liver stiffness (by Fibroscan), elasticity index (RTE), FIB4 score and APRI score, regardless of the response to DAAs. Moreover, there was a significant increase in platelet count from baseline to SVR24. The average improvement of the liver stiffness in different fibrosis stages was 22%. There was a positive correlation between stiffness score and all other fibrosis markers before and after treatment. Conclusion There was a significant improvement of liver stiffness after 12 weeks of end of treatment, regardless of the DAA regimen used, and regardless of the treatment outcome (response), as evidenced by Fibroscan, RTE, FIB4 and APRI scores.