Direkt etkili antiviral ajanlarla tedavi olan hepatit C hastalarında non-invaziv fibrozis indeks değerlerinin değişimi
Abstract
Giriş ve Amaç: Her yıl yaklaşık 400 000 hepatit C virüs hastası siroza bağlı komplikasyonlardan ve hepatosellüler karsinomadan ölmektedir. Doğrudan etkili antiviraller, hepatit C virüs enfeksiyonu olan hastaların %90’ından fazlasında sürekli bir virolojik yanıt sağlar. Bu çalışmada doğrudan etkili antivirallerle tedavi edilen hepatit C virüslü hastalarda non-invaziv fibrozis indeksindeki değişikliği değerlendirmeyi amaçladık. Gereç ve Yöntem: Doğrudan etkili antiviral teadavisi alan hepatit C virüslü hastalar analiz edildi. Her hasta için FIB-4 ve APRI hesaplandı. Bulgular: Toplam 88 hastanın 46'sı (%52) erkek, 21'i (%23.8) sirotikti. Ortalama yaş 58 yıl idi. Başlangıçtan tedavi bitimine kadar non-invaziv skorlarda anlamlı düşüş gösterildi (p < 0.001). Başlangıçtan sürekli bir virolojik yanıt sonrasına kadar ortalama FIB-4 ve APRI skorlarında istatistiksel olarak anlamlı bir düşüş vardı (p < 0.001). Uzun süreli takipte, sürekli bir virolojik yanıt sonrası 15 ayda düşük FIB-4 ve APRI'nin devam ettiği gözlendi. Çalışmamızda ortalama takip süresi 27.8 ± 24.3 ay olup, takipte doğrudan etkili antiviral tedavisi sonrası sadece bir hastaya hepatosellüler kanser tanısı konuldu. Sonuç: FIB-4 ve APRI skorlarındaki erken düşüş, karaciğer enzimlerindeki azalma ile ilişkili olabilir. Bununla birlikte, takiplerde düşük düzeyde invaziv olmayan skorların devam etmesi, nekroinflamasyonda bir azalma ile ilişkilendirilmiştir.
References
- 1. World Health Organization. "Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021: accountability for the global health sector strategies 2016–2021: actions for impact: web annex 2: data methods." (2021).
- 2. Garg G, Dixit VK, Shukla SK, et al. Impact of direct acting antiviral drugs in treatment naïve HCV cirrhosis on fibrosis and severity of liver disease: A real life experience from a tertiary care center of North India. J Clin Exp Hepatol 2018;8:241-9.
- 3. Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: A multicenter prospective study (the FIBROSTIC study). J Hepatol 2010;53:1013-21.
- 4. Catanzaro R, Aleo A, Sciuto M, et al. FIB-4 and APRI scores for predicting severe liver fibrosis in chronic hepatitis HCV patients: A monocentric retrospective study. Clin Exp Hepatol 2021;7:111-6.
- 5. Verlinden W, Bourgeois S, De Maeyer M, et al. Validation of APRI and FIB-4 score in an Antwerp cohort of chronic hepatitis C patients. Acta Gastroenterol Belg 2015;78:373-80.
- 6. Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral direct-acting agent therapy for hepatitis C virus infection: A systematic review. Ann Intern Med 2018;166:637-48.
- 7. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol 2021;75:659-89.
- 8. Sterling RK, Lissen E, Clumeck N, et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317-25.
- 9. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
- 10. Bachofner JA, Valli PV, Kröger A, et al. Direct antiviral agent treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers fibrosis‐4 score and aspartate aminotransferase‐platelet ratio index. Liver Int 2017;37:369-76.
- 11. Leuştean A, Popescu C, Nichita L, Tilişcan C, Aramă V. Dynamics of APRI and FIB-4 in HCV cirrhotic patients who achieved SVR after DAA therapy. Exp Ther Med 2021;21:99.
- 12. Bakır A, Güney M, Erdal H, et al. Assessment of the performances of hepatitis C virus viral markers, age-platelet index and aspartate aminotransferase to alanine aminotransferase ratio scores, in predicting liver histopathology. Turk J Int Med 2021;3:6-12.
- 13. Rinaldi L, Di Francia R, Coppola N, et al. Hepatocellular carcinoma in HCV cirrhosis after viral clearance with direct acting antiviral therapy: Preliminary evidence and possible meanings. WCRJ. 2016;3:e748.
- 14. Cardoso H, Vale AM, Rodrigues S, et al. High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis. J. Hepatol 2016;65:1070-1.
- 15. Ioannou GN, Feld JJ. What are the benefits of a sustained virologic response to direct-acting antiviral therapy for hepatitis C virus infection? Gastroenterology 2019;156:446-60.
- 16. Rinaldi L, Nevola R, Franci G, et al. Risk of hepatocellular carcinoma after HCV clearance by direct-acting antivirals treatment. Predictive factors and fole of epigenetics. Cancers (Basel) 2020;12:1351.
The changing non-invasive fibrosis index value in patients with hepatitis C treated with direct-acting antiviral agents
Abstract
Background and Aims: About 400 000 patients with hepatitis C virus die from cirrhosis-related complications and hepatocellular carcinoma every year. Direct-acting antivirals provide a sustained virologic response in more than 90% of patients with hepatitis C virus infection. We aimed to evaluate the alteration of the non-invasive fibrosis index in patients with hepatitis C virus who were treated with direct-acting antivirals. Materials and Method: Patients with hepatitis C virus who received a complete course of direct-acting antivirals were analyzed. FIB-4 and APRI were calculated for each patient. Results: Of the 88 patients, 46 (52%) were males, and 21 (23.8%) were cirrhotics. The mean age was 58 years. The significant decrease was showed in the non-invasive scores compared from the baseline to the end of treatment. There was a statistically significant drop in mean FIB-4 and APRI scores from baseline to post sustained virologic response (p < 0.001). In the long-term follow-up, it was observed to continue low FIB-4 and APRI at 15 months post sustained virologic response. Mean follow up-time was 27.8 ± 24.3 months in our study, and just one patient was diagnosed with hepatocellular cancer after direct-acting antivirals treatment during follow-up. Conclusion: An early decline in FIB-4 and APRI scores can be related to a decrease in liver enzymes. Nonetheless, maintaining a low level of non-invasive markers has been linked to a reduction in necroinflammation.
References
- 1. World Health Organization. "Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021: accountability for the global health sector strategies 2016–2021: actions for impact: web annex 2: data methods." (2021).
- 2. Garg G, Dixit VK, Shukla SK, et al. Impact of direct acting antiviral drugs in treatment naïve HCV cirrhosis on fibrosis and severity of liver disease: A real life experience from a tertiary care center of North India. J Clin Exp Hepatol 2018;8:241-9.
- 3. Degos F, Perez P, Roche B, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: A multicenter prospective study (the FIBROSTIC study). J Hepatol 2010;53:1013-21.
- 4. Catanzaro R, Aleo A, Sciuto M, et al. FIB-4 and APRI scores for predicting severe liver fibrosis in chronic hepatitis HCV patients: A monocentric retrospective study. Clin Exp Hepatol 2021;7:111-6.
- 5. Verlinden W, Bourgeois S, De Maeyer M, et al. Validation of APRI and FIB-4 score in an Antwerp cohort of chronic hepatitis C patients. Acta Gastroenterol Belg 2015;78:373-80.
- 6. Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, et al. Oral direct-acting agent therapy for hepatitis C virus infection: A systematic review. Ann Intern Med 2018;166:637-48.
- 7. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol 2021;75:659-89.
- 8. Sterling RK, Lissen E, Clumeck N, et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317-25.
- 9. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
- 10. Bachofner JA, Valli PV, Kröger A, et al. Direct antiviral agent treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers fibrosis‐4 score and aspartate aminotransferase‐platelet ratio index. Liver Int 2017;37:369-76.
- 11. Leuştean A, Popescu C, Nichita L, Tilişcan C, Aramă V. Dynamics of APRI and FIB-4 in HCV cirrhotic patients who achieved SVR after DAA therapy. Exp Ther Med 2021;21:99.
- 12. Bakır A, Güney M, Erdal H, et al. Assessment of the performances of hepatitis C virus viral markers, age-platelet index and aspartate aminotransferase to alanine aminotransferase ratio scores, in predicting liver histopathology. Turk J Int Med 2021;3:6-12.
- 13. Rinaldi L, Di Francia R, Coppola N, et al. Hepatocellular carcinoma in HCV cirrhosis after viral clearance with direct acting antiviral therapy: Preliminary evidence and possible meanings. WCRJ. 2016;3:e748.
- 14. Cardoso H, Vale AM, Rodrigues S, et al. High incidence of hepatocellular carcinoma following successful interferon-free antiviral therapy for hepatitis C associated cirrhosis. J. Hepatol 2016;65:1070-1.
- 15. Ioannou GN, Feld JJ. What are the benefits of a sustained virologic response to direct-acting antiviral therapy for hepatitis C virus infection? Gastroenterology 2019;156:446-60.
- 16. Rinaldi L, Nevola R, Franci G, et al. Risk of hepatocellular carcinoma after HCV clearance by direct-acting antivirals treatment. Predictive factors and fole of epigenetics. Cancers (Basel) 2020;12:1351.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 29, 2022 |
| Published in Issue | Year 2022 Volume: 21 Issue: 3 |
test-5