Exploring the liver microenvironment following successful therapy for HCV: gene expression profiling and residual T...

Direct-acting antivirals (DAAs) revolutionized hepatitis C (HCV) treatment. Yet, some patients present with persistent inflammation and still face adverse outcomes, including cirrhosis and hepatocellular carcinoma, despite achieving sustained virologic response (SVR).

This study examined liver biopsies from 22 patients before and after DAA treatment to assess gene and protein expression changes linked to disease progression. Pre-treatment, patients exhibited two distinct profiles: one characterized by high pro-inflammatory and antiviral gene expression (pre-hot), and another with weaker expression (pre-cold). Patients with pre-hot profiles were initially associated with poor outcomes (OR = 14.0, 95% CI: 1.31-178.5; p = 0.049), but this lost significance after adjusting for baseline disease severity (adjusted OR = 8.04, 95% CI: 0.18-2123.07; p = 0.328). Baseline modified hepatitis activity index (MHAI) scores (OR = 1.90, 95% CI: 0.72-6.34) and fibrosis stage (OR = 1.65, 95% CI: 0.44-9.97) trended toward predicting poor outcomes but were not significant. Post-treatment, liver enzymes decreased, inflammatory scores improved, and type I interferon pathways were restored, yet 14 of 17 patients (82.3%, 95% CI: 64.2-100%) retained persistent lymphocytic infiltrates. In parallel, spectral imaging further revealed post-treatment shifts in macrophage populations, with a significant decrease in inflammatory subsets (CD14+, CD14+/Mac387+, p<0.05) and an increase in anti-inflammatory subsets (CD16+, CD16+/CD163+, CD16+/CD68+, p<0.05). Analysis of T cell-related marker expression before and after treatment shows that mixed lymphocytic infiltration (CD3+, CD4+, CD8+, CD45RO+) persists within the liver despite viral clearance, with high inter-patient variability likely limiting statistical significance.

Even after achieving SVR and normalization of gene expression, the liver retained a heterogeneous T cell infiltrate, suggesting that persistent immune activity could continue to influence the risk of adverse outcomes.