Fatty liver in hepatitis C patients post-sustained virological response with direct-acting antivirals

World J Gastroenterol. 2018 Mar 21;24(11):1269-1277. doi: 10.3748/wjg.v24.i11.1269.

Abstract

Aim: To determine steatosis and fibrosis prevalence in hepatitis C patients after a sustained virological response achieved with direct-acting antivirals.

Methods: Transient elastography with controlled attenuation parameter (CAP) was used to assess hepatic steatosis post-sustained virological response (SVR); the CAP technology was not available in the United States at study initiation. Liver stiffness/fibrosis was measured before and 47 wk after treatment completion. Patients with genotype 3 and patients with cirrhosis were excluded.

Results: One hundred and one patients were included in the study. Post-SVR there were decreases from baseline in alanine aminotransferase (ALT) (63.1 to 17.8 U/L), aspartate aminotransferase (51.8 to 21.5 U/L) and fibrosis score (7.4 to 6.1 kPa) (P < 0.05). Post-SVR, 48 patients (47.5%) had steatosis on CAP; of these, 6.25% had advanced fibrosis. Patients with steatosis had higher body mass index (29.0 vs 26.1 kg/m2), glucose (107.8 vs 96.6 mg/dL), ALT (20.4 vs 15.3 mg/dL), CAP score (296.3 vs 212.4 dB/m) and fibrosis score (7.0 vs 5.3 kPa); P < 0.05. Interestingly, compared to baseline, both patients with and without steatosis had change in fibrosis score post-SVR (7.7 kPa vs 7.0 kPa and 7.0 kPa vs 5.3 kPa); alternatively, (P < 0.05) and therefore patients with steatosis continued to have clinically significant stiffness (≥ 7 kPa).

Conclusion: Fatty liver is very common in hepatitis C virus (HCV) patients post-SVR. These patients continue to have elevated mean fibrosis score (≥ 7 kPa) compared to those without fatty liver; some have advanced fibrosis. Long term follow up is needed to assess steatosis and fibrosis in HCV patients post-SVR.

Keywords: Direct-acting antivirals; Fibrosis; Hepatitis C; Nonalcoholic fatty liver disease; Steatosis; Sustained virological response.

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use*
  • Cross-Sectional Studies
  • Elasticity Imaging Techniques / methods
  • Fatty Liver / diagnostic imaging
  • Fatty Liver / epidemiology*
  • Fatty Liver / pathology
  • Fatty Liver / virology
  • Female
  • Hepacivirus / drug effects
  • Hepacivirus / isolation & purification
  • Hepatitis C, Chronic / diagnostic imaging
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / pathology
  • Hepatitis C, Chronic / virology
  • Humans
  • Liver / diagnostic imaging
  • Liver / pathology*
  • Liver Cirrhosis / diagnostic imaging
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Sustained Virologic Response
  • United States / epidemiology

Substances

  • Antiviral Agents