Year 2010 / Volume 102 / Number 7
Original
Hepatic fibrosis in patients with chronic hepatitis C assessed by transient elastography: implications for determining the efficacy of antiviral therapy

pp. 426-434

J. Mendoza, M. Trapero-Marugán, L. González-Moreno, E. A. Jones, E. Gómez-Domínguez and R. Moreno-Otero

Abstract
Background: the efficacy of combination therapy with peginterferon plus ribavirin to eradicate viral infection in patients with chronic hepatitis C (CHC) is well established; moreover, it is able to arrest or even reverse liver fibrosis.

Aims: to analyze the measurements of hepatic stiffness as an index of liver fibrosis using transient elastography (TE) in patients who underwent a sustained virological response (SVR) during
long-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 with
CHC 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 biopsies revealed active disease and fibrosis (stage 3) in two and mild fibrosis (stage 1) in one. After several years of follow up serum AST/ALT levels were normal and HCV RNA was undetectable in each 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 the SVR group improved in 7 (88%) patients, whereas in the non-responder it improved in only 4 (25%) (p < 0.05). The difference between development of severe fibrosis (F = 3) in responders and non-responders was not significant (p = 0.23), possibly due to the
small sample size.

Conclusions: regression of hepatic fibrosis appears to be common in patients with CHC who undergo a SVR. TE is a simple non-invasive technique that enables multiple assessments of the severity of hepatic fibrosis to be made efficiently during longterm follow-up of patients with CHC who receive combination antiviral therapy.
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J. Mendoza, M. Trapero-Marugán, L. González-Moreno, E. A. Jones, E. Gómez-Domínguez and R. Moreno-Otero. Hepatic fibrosis in patients with chronic hepatitis C assessed by transient elastography: implications for determining the efficacy of antiviral therapy. 426-434


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