Direct-acting antiviral therapy of chronic hepatitis C improves liver fibrosis, assessed by histological examination and laboratory markers

Background/Purpose: Direct-acting antiviral agents achieve sustained virological response in most chronic hepatitis C patients. However, histological responses are not consistent among all patients. We conducted an observational study to analyze the histological changes after direct-acting antiviral agent therapy. Methods: We recruited 220 patients who achieved sustained virological response after direct acting antiviral agent. Histology was assessed by liver biopsy and laboratory indices including fibrosis-4 and aspartate aminotransferase to platelet ratio index. Primary outcomes were change in the dynamic laboratory results. Secondary outcomes were histological changes on liver biopsy. We analyzed the factors predictive of histological regression. Results: The mean fibrosis-4 index decreased from 4.78 at baseline to 3.30, 3.31, 3.65, and 3.66 at week 4, 8, end of treatment, and 12 weeks after treatment, respectively (all p < 0.01). Mean aspartate aminotransferase to platelet ratio index decreased from 1.62 at baseline to 0.61, 0.66, 0.64, and 0.82 at week 4, 8, end of treatment, and 12 weeks after treatment, respectively (all p < 0.01). Mean Histological Activity Index at baseline and posttreatment was 6.9 +/- 1.9 and 5.0 +/- 2.3. The METAVIR fibrosis scores improved in 61.9% of the patients. We compared patients who achieved fibrosis-regression with the non regression group. There was no significant difference in the baseline host/virological factors between the groups. Conclusion: Reversal of liver inflammation and fibrosis was achieved in a significant number of patients who received direct-acting antiviral agent. No baseline host or virological factor was predictive of histological regression after antiviral treatment. Copyright (C) 2020, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).