Elastography is unable to exclude cirrhosis after sustained virological response in HCV-infected patients with...

Area of Science:

• Hepatology
• Virology
• Diagnostic Imaging

Background:

• The correlation between liver fibrosis staging via transient elastography (TE) and outcomes in hepatitis C virus (HCV)-infected patients with compensated advanced chronic liver disease (cACLD) following sustained virological response (SVR) remains unclear.
• Understanding this relationship is crucial for managing patients post-HCV eradication.

Purpose of the Study:

• To assess the accuracy of transient elastography (TE) in identifying cirrhosis in patients with compensated advanced chronic liver disease (cACLD) three years after achieving a sustained virological response (SVR) to hepatitis C virus (HCV) treatment.

Main Methods:

• A prospective, multi-centric study enrolled HCV-cACLD patients prior to direct-acting antiviral (DAA) therapy.
• The diagnostic accuracy of TE to identify cirrhosis (METAVIR F4) three years post-SVR was evaluated using the area under the receiver operating characteristic curve (AUROC).
• Liver biopsy, TE, APRI, and FIB-4 scores were assessed before and after treatment.

Main Results:

• Among 746 patients, 76 underwent liver biopsy 3 years post-SVR, revealing cirrhosis in 41 (53.9%).
• TE values, APRI, and FIB-4 scores improved post-SVR, but TE accuracy for cirrhosis detection was poor (AUROC=0.75).
• HCV genotype 3 and pre-treatment TE were significant predictors of cirrhosis post-SVR, while post-SVR TE, APRI, and FIB-4 showed limited diagnostic value.

Conclusions:

• Cirrhosis is prevalent in over half of HCV-cACLD patients three years after SVR, despite improvements in liver function and non-invasive test scores.
• The low diagnostic accuracy of non-invasive methods, including TE, APRI, and FIB-4, after SVR highlights the need for continued long-term surveillance in these patients.
• HCV genotype 3 and baseline TE are crucial factors for predicting long-term fibrosis progression.